{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T23:32:42Z","timestamp":1787009562439,"version":"build-2736575974"},"reference-count":29,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2019,11,9]],"date-time":"2019-11-09T00:00:00Z","timestamp":1573257600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,7,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This retrospective cohort study tested the hypothesis that implementing a multidisciplinary patient-specific discharge protocol for prescribing and tapering opioids after total hip arthroplasty (THA) will decrease the morphine milligram equivalent (MME) dose of opioids prescribed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>With institutional review board approval, we analyzed a Perioperative Surgical Home database and prescription data for all primary THA patients three months before (PRE) and three months after (POST) implementation of this new discharge opioid protocol based on patients\u2019 prior 24-hour inpatient opioid consumption. The primary outcome was total opioid dosage in MME prescribed and opioid refills for six weeks after surgery. Secondary outcomes included the number of tablets and MME prescribed at discharge, in-hospital opioid consumption, length of stay, and postoperative complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Forty-nine cases (25 PRE and 24 POST) were included. Total median (10th\u201390th percentiles) MME for six weeks postoperatively was 900 (57\u20132082) MME PRE vs 295 (69\u2013741) MME POST (mean difference = 721, 95% confidence interval [CI] = 127\u20131316, P\u2009=\u20090.007, Mann-Whitney U test). Refill rates did not differ. The median (10th\u201390th percentiles) initial discharge prescription in MME was 675 (57\u20131035) PRE vs 180 (18\u2013534) POST (mean difference = 387, 95% CI = 156\u2013618, P\u2009=\u20090.003, Mann-Whitney U test) MME. There were no differences in other outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Implementation of a patient-specific prescribing and tapering protocol decreases the mean six-week dosage of opioid prescribed by 63% after THA without increasing the refill rate.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/pm\/pnz260","type":"journal-article","created":{"date-parts":[[2019,9,26]],"date-time":"2019-09-26T07:29:04Z","timestamp":1569482944000},"page":"1474-1481","source":"Crossref","is-referenced-by-count":34,"title":["A Multidisciplinary Patient-Specific Opioid Prescribing and Tapering Protocol Is Associated with a Decrease in Total Opioid Dose Prescribed for Six Weeks After Total Hip Arthroplasty"],"prefix":"10.1093","volume":"21","author":[{"given":"Mallika","family":"Tamboli","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California"},{"name":"Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward R","family":"Mariano","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California"},{"name":"Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kerianne E","family":"Gustafson","sequence":"first","affiliation":[{"name":"Orthopaedic Surgery Section, Surgical Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beverly L","family":"Briones","sequence":"first","affiliation":[{"name":"Orthopaedic Surgery Section, Surgical Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oluwatobi O","family":"Hunter","sequence":"first","affiliation":[{"name":"Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel R","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California"},{"name":"Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T Kyle","family":"Harrison","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California"},{"name":"Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex","family":"Kou","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California"},{"name":"Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seshadri C","family":"Mudumbai","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California"},{"name":"Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T Edward","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California"},{"name":"Anesthesiology and Perioperative Care Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pier F","family":"Indelli","sequence":"first","affiliation":[{"name":"Orthopaedic Surgery Section, Surgical Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California"},{"name":"Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas J","family":"Giori","sequence":"first","affiliation":[{"name":"Orthopaedic Surgery Section, Surgical Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, California"},{"name":"Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2019,11,9]]},"reference":[{"issue":"4","key":"2020070807042697800_pnz260-B1","doi-asserted-by":"crossref","first-page":"500","DOI":"10.2105\/AJPH.2017.304265","article-title":"Quantifying the epidemic of prescription opioid overdose deaths","volume":"108","author":"Seth","year":"2018","journal-title":"Am J Public Health"},{"key":"2020070807042697800_pnz260-B2"},{"issue":"6","key":"2020070807042697800_pnz260-B3","doi-asserted-by":"crossref","first-page":"e170504","DOI":"10.1001\/jamasurg.2017.0504","article-title":"New persistent opioid use after minor and major surgical procedures in US adults","volume":"152","author":"Brummett","year":"2017","journal-title":"JAMA 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