{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T17:46:52Z","timestamp":1777657612768,"version":"3.51.4"},"reference-count":53,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2024,1,1]],"date-time":"2024-01-01T00:00:00Z","timestamp":1704067200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","award":["R01AG065722 and R01AG077620"],"award-info":[{"award-number":["R01AG065722 and R01AG077620"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Geriatr Orthop Surg Rehabil"],"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Limited evidence exists on health system characteristics associated with initial and long-term prescribing of opioids and nonsteroidal anti-inflammatory drugs (NSAIDs) following total hip and knee arthroplasty (THA\/TKA), and if these characteristics differ among individuals based on preoperative NSAID exposure. We identified orthopedic surgeon opioid prescribing practices, hospital characteristics, and regional factors associated with initial and long-term prescribing of opioids and NSAIDs among older adults receiving THA\/TKA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>This observational study included opioid-na\u00efve Medicare beneficiaries aged \u226565\u00a0years receiving elective THA\/TKA between January 1, 2014 and July 4, 2017. We examined initial (days 1-30 following THA\/TKA) and long-term (days 90-180) opioid or NSAID prescribing, stratified by preoperative NSAID exposure. Risk ratios (RRs) for the associations between 10 health system characteristics and case-mix adjusted outcomes were estimated using multivariable Poisson regression models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The study population included 23,351 NSAID-na\u00efve and 10,127 NSAID-prevalent individuals. Increases in standardized measures of orthopedic surgeon opioid prescribing generally decreased the risk of initial NSAID prescribing but increased the risk of long-term opioid prescribing. For example, among NSAID-na\u00efve individuals, the RRs (95% confidence intervals [CIs]) for initial NSAID prescribing were 0.95 (0.93-0.97) for 1-2 orthopedic surgeon opioid prescriptions per THA\/TKA procedure, 0.94 (0.92-0.97) for 3-4 prescriptions per procedure, and 0.91 (0.89-0.93) for 5+ opioid prescriptions per procedure (reference: &lt;1 opioid prescription per procedure), while the RRs (95% CIs) for long-term opioid prescribing were 1.06 (1.04-1.08), 1.08 (1.06-1.11), and 1.13 (1.11-1.16), respectively. Variation in postoperative analgesic prescribing was observed across U.S. regions. For example, among NSAID-na\u00efve individuals, the RR (95% CIs) for initial opioid prescribing were 0.98 (0.96-1.00) for Region 2 (New York), 1.09 (1.07-1.11) for Region 3 (Philadelphia), 1.07 (1.05-1.10) for Region 4 (Atlanta), 1.03 (1.01-1.05) for Region 5 (Chicago), 1.16 (1.13-1.18) for Region 6 (Dallas), 1.10 (1.08-1.12) for Region 7 (Kansas City), 1.09 (1.06-1.12) for Region 8 (Denver), 1.09 (1.07-1.12) for Region 9 (San Francisco), and 1.11 (1.08-1.13) for Region 10 (Seattle) (reference: Region 1 [Boston]). Hospital characteristics were not meaningfully associated with postoperative analgesic prescribing. The relationships between health system characteristics and postoperative analgesic prescribing were similar for NSAID-na\u00efve and NSAID-prevalent participants.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Future efforts aiming to improve the use of multimodal analgesia through increased NSAID prescribing and reduced long-term opioid prescribing following THA\/TKA could consider targeting orthopedic surgeons with higher standardized opioid prescribing measures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Orthopedic surgeon opioid prescribing measures and U.S. region were the greatest health system level predictors of initial, and long-term, prescribing of opioids and prescription NSAIDs among older Medicare beneficiaries following THA\/TKA. These results can inform future studies that examine why variation in analgesic prescribing exists across geographic regions and levels of orthopedic surgeon opioid prescribing.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/21514593241266715","type":"journal-article","created":{"date-parts":[[2024,8,13]],"date-time":"2024-08-13T21:22:05Z","timestamp":1723584125000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Initial and Long-Term Prescribing of Opioids and Non-steroidal Anti-inflammatory Drugs Following Total Hip and Knee Arthroplasty"],"prefix":"10.1177","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2196-0134","authenticated-orcid":false,"given":"Melissa R.","family":"Riester","sequence":"first","affiliation":[{"name":"Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA"},{"name":"Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA"},{"name":"Center for Gerontology and Healthcare Research, School of Public Health, Brown University School of Public Health, Providence, RI, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elliott","family":"Bosco","sequence":"additional","affiliation":[{"name":"Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA"},{"name":"Center for Gerontology and Healthcare Research, School of Public Health, Brown University School of Public Health, Providence, RI, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesca L.","family":"Beaudoin","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA"},{"name":"Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefan","family":"Gravenstein","sequence":"additional","affiliation":[{"name":"Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA"},{"name":"Center for Gerontology and Healthcare Research, School of Public Health, Brown University School of Public Health, Providence, RI, USA"},{"name":"Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, RI, USA"},{"name":"Department of Medicine, Warren Alpert Medical School, Brown University, Providence, RI, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew J.","family":"Schoenfeld","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, MA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vincent","family":"Mor","sequence":"additional","affiliation":[{"name":"Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA"},{"name":"Center for Gerontology and Healthcare Research, School of Public Health, Brown University School of Public Health, Providence, RI, USA"},{"name":"Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, RI, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew R.","family":"Zullo","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA"},{"name":"Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA"},{"name":"Center for Gerontology and Healthcare Research, School of Public Health, Brown University School 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