{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,30]],"date-time":"2025-08-30T00:06:55Z","timestamp":1756512415415,"version":"3.44.0"},"reference-count":47,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T00:00:00Z","timestamp":1756425600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Mitacs Globalink Research Award"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>Opioid analgesics are commonly prescribed after total knee and hip arthroplasty to manage pain. Rates of opioid prescribing after arthroplasty differ by country, suggesting differences in policies or surgeons\u2019 practices. We adopted a qualitative description design to explore and compare Canadian, Dutch, and Japanese orthopaedic surgeons\u2019 perceptions of facilitators and barriers to opioid reduction after total joint arthroplasty. We used a combination of convenience and purposive sampling, and snowball recruitment to facilitate 27 semi-structured interviews online or via a phone call. We concurrently collected and analyzed data using conventional (inductive) content analysis. In our sample, all Canadian surgeons and almost all Dutch surgeons prescribed opioids to all arthroplasty patients post-discharge. Surgeons in Japan showed much greater variability, with half of those interviewed prescribing opioids to only a minority or no patients post-discharge. Japanese surgeons indicated that a 10\u201330-day hospital stay was typical after surgery and believed that opioids were often unnecessary for managing postoperative pain. Dutch surgeons described using an institutional standard pain management protocol, while Canadian and Japanese surgeons noted high variability in the type and dose of opioids prescribed, even within the same institution. Orthopaedic surgeons in each country identified challenges and facilitators to reduced postoperative opioid use in six key areas: (1) opioid prescribing practices, (2) patient factors, (3) collaborative care, (4) opioid prescribing policies\/guidelines, (5) surgeon education, and (6) personal perceptions\/beliefs. Canadian, Dutch, and Japanese orthopedic surgeons in our study described a range of individual, patient, and system level contributors to variability in opioid prescribing after joint replacement surgery. These findings suggest that multifactorial and context-specific approaches may be required to address barriers and optimize postoperative use of opioids.<\/jats:p>","DOI":"10.1371\/journal.pone.0331335","type":"journal-article","created":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T17:40:23Z","timestamp":1756489223000},"page":"e0331335","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Perceptions of barriers and facilitators to opioid reduction after total joint arthroplasty among orthopedic surgeons practicing in Canada, Japan, and the Netherlands: A qualitative description study"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7917-8666","authenticated-orcid":true,"given":"Mansi","family":"Patel","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-7450-5435","authenticated-orcid":true,"given":"Parsia","family":"Parnian","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2861-9636","authenticated-orcid":true,"given":"Kim","family":"Madden","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sheila","family":"Sprague","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9901-2946","authenticated-orcid":true,"given":"Anita","family":"Acai","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ydo","family":"Kleinlugtenbelt","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Natsumi","family":"Saka","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ellie","family":"Landman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4105-4465","authenticated-orcid":true,"given":"Harsha","family":"Shanthanna","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vickas","family":"Khanna","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0178-8712","authenticated-orcid":true,"given":"Jason W.","family":"Busse","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2025,8,29]]},"reference":[{"issue":"4","key":"pone.0331335.ref001","doi-asserted-by":"crossref","first-page":"689","DOI":"10.1007\/s00296-022-05094-4","article-title":"Acute pain after total hip and knee arthroplasty does not affect chronic pain during the first postoperative year: observational cohort study of 389 patients","volume":"42","author":"DAJM Latijnhouwers","year":"2022","journal-title":"Rheumatol Int"},{"key":"pone.0331335.ref002","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1093\/milmed\/usaa573","article-title":"Identifying patterns and predictors of prescription opioid use after total joint arthroplasty","volume":"186","author":"MA Chaudhary","year":"2021","journal-title":"Mil Med"},{"key":"pone.0331335.ref003","doi-asserted-by":"crossref","unstructured":"Jalali MS, Botticelli M, Hwang R, Koh H, McHugh R. The opioid crisis: a contextual, social-ecological framework. 2020.","DOI":"10.1186\/s12961-020-00596-8"},{"issue":"2","key":"pone.0331335.ref004","doi-asserted-by":"crossref","first-page":"248","DOI":"10.3122\/jabfm.2017.02.160299","article-title":"Comparison of opioid prescribing patterns in the united states and japan: primary care physicians\u2019 attitudes and perceptions","volume":"30","author":"E Onishi","year":"2017","journal-title":"J Am Board Fam Med"},{"issue":"12","key":"pone.0331335.ref005","doi-asserted-by":"crossref","first-page":"787","DOI":"10.12788\/jhm.3277","article-title":"Pain in the United States: time for a culture shift in expectations, messaging, and management","volume":"14","author":"FE Loh","year":"2019","journal-title":"J Hosp Med"},{"issue":"9","key":"pone.0331335.ref006","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2019.10734","article-title":"Opioid prescribing after surgery in the United States, Canada, and Sweden","volume":"2","author":"KS Ladha","year":"2019","journal-title":"JAMA Netw Open"},{"issue":"10324","key":"pone.0331335.ref007","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1016\/S0140-6736(21)02252-2","article-title":"Responding to the opioid crisis in North America and beyond: recommendations of the Stanford-Lancet Commission","volume":"399","author":"K Humphreys","year":"2022","journal-title":"Lancet"},{"key":"pone.0331335.ref008","article-title":"Opioid- and stimulant-related harms in Canada.","volume-title":"Canada OPHA o, editor","author":"Federal p, territorial Special Advisory Committee on the Epidemic of Opioid Overdoses","year":"2023"},{"issue":"10","key":"pone.0331335.ref009","article-title":"Are we facing an opioid crisis in Europe?","volume":"4","author":"KMC Verhamme","year":"2019","journal-title":"Lancet Public Health"},{"issue":"10","key":"pone.0331335.ref010","doi-asserted-by":"crossref","DOI":"10.1016\/S2468-2667(19)30128-8","article-title":"Trends in use and misuse of opioids in the Netherlands: a retrospective, multi-source database study","volume":"4","author":"GA Kalkman","year":"2019","journal-title":"Lancet Public Health"},{"issue":"20","key":"pone.0331335.ref011","doi-asserted-by":"crossref","DOI":"10.1097\/MD.0000000000015425","article-title":"Current perspectives on the opioid crisis in the US healthcare system: A comprehensive literature review","volume":"98","author":"N Stoicea","year":"2019","journal-title":"Medicine (Baltimore)"},{"issue":"6","key":"pone.0331335.ref012","first-page":"731","article-title":"Social and legal factors related to drug abuse in the United States and Japan","volume":"109","author":"SB Greberman","year":"1994","journal-title":"Public Health Rep"},{"issue":"4","key":"pone.0331335.ref013","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1002\/1098-240X(200008)23:4<334::AID-NUR9>3.0.CO;2-G","article-title":"Whatever happened to qualitative description?","volume":"23","author":"M Sandelowski","year":"2000","journal-title":"Res Nurs Health"},{"issue":"6","key":"pone.0331335.ref014","doi-asserted-by":"crossref","first-page":"3319","DOI":"10.3390\/ijerph19063319","article-title":"A qualitative description of resident physicians\u2019 understanding of child maltreatment: impacts, recognition, and response","volume":"19","author":"M Laupacis","year":"2022","journal-title":"Int J Environ Res Public Health"},{"issue":"1","key":"pone.0331335.ref015","first-page":"60","article-title":"An introduction to qualitative health research","volume":"72","author":"M Luciani","year":"2019","journal-title":"Prof Inferm"},{"issue":"1","key":"pone.0331335.ref016","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1002\/nur.21768","article-title":"Characteristics of qualitative descriptive studies: a systematic review","volume":"40","author":"H Kim","year":"2017","journal-title":"Res Nurs Health"},{"key":"pone.0331335.ref017","volume-title":"Interpretive description: qualitative research for applied practice","author":"S Thorne","year":"2016","edition":"2"},{"issue":"1","key":"pone.0331335.ref018","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1186\/s12875-019-0947-2","article-title":"Understanding the behavioural determinants of opioid prescribing among family physicians: a qualitative study","volume":"20","author":"L Desveaux","year":"2019","journal-title":"BMC Fam Pract"},{"issue":"11","key":"pone.0331335.ref019","doi-asserted-by":"crossref","first-page":"1689","DOI":"10.1111\/pme.12172","article-title":"Contrasting tensions between patients and PCPs in chronic pain management: a qualitative study","volume":"14","author":"AA Bergman","year":"2013","journal-title":"Pain Med"},{"issue":"9","key":"pone.0331335.ref020","doi-asserted-by":"crossref","first-page":"1277","DOI":"10.1177\/1049732305276687","article-title":"Three approaches to qualitative content analysis","volume":"15","author":"H-F Hsieh","year":"2005","journal-title":"Qual Health Res"},{"issue":"1","key":"pone.0331335.ref021","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1111\/j.1365-2648.2007.04569.x","article-title":"The qualitative content analysis process","volume":"62","author":"S Elo","year":"2008","journal-title":"J Adv Nurs"},{"key":"pone.0331335.ref022","doi-asserted-by":"crossref","first-page":"100067","DOI":"10.1016\/j.metip.2021.100067","article-title":"Joint displays for mixed methods research in psychology","volume":"5","author":"MT McCrudden","year":"2021","journal-title":"Methods Psychol"},{"key":"pone.0331335.ref023","first-page":"1189","article-title":"Enhancing the quality and credibility of qualitative analysis","volume":"34","author":"MQ Patton","year":"1999","journal-title":"Health Serv Res"},{"issue":"6","key":"pone.0331335.ref024","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1093\/intqhc\/mzm042","article-title":"Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups","volume":"19","author":"A Tong","year":"2007","journal-title":"Int J Qual Health Care"},{"issue":"2","key":"pone.0331335.ref025","first-page":"208","article-title":"Availability and utilization of opioids for pain management: global issues","volume":"14","author":"D Manjiani","year":"2014","journal-title":"Ochsner J"},{"issue":"10180","key":"pone.0331335.ref026","doi-asserted-by":"crossref","first-page":"1547","DOI":"10.1016\/S0140-6736(19)30428-3","article-title":"Inappropriate opioid prescription after surgery","volume":"393","author":"MD Neuman","year":"2019","journal-title":"Lancet"},{"issue":"12","key":"pone.0331335.ref027","doi-asserted-by":"crossref","first-page":"737","DOI":"10.12788\/jhm.3256","article-title":"Opioid utilization and perception of pain control in hospitalized patients: a cross-sectional study of 11 sites in 8 countries","volume":"14","author":"M Burden","year":"2019","journal-title":"J Hosp Med"},{"issue":"3","key":"pone.0331335.ref028","doi-asserted-by":"crossref","first-page":"520","DOI":"10.1016\/j.jos.2019.04.014","article-title":"Comparison of opioid use and prescribing patterns in orthopedic surgery in Japan and the United States: A JOA-AOA traveling fellowship investigation","volume":"25","author":"C Tannoury","year":"2020","journal-title":"J Orthop Sci"},{"issue":"1","key":"pone.0331335.ref029","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1007\/s11999.0000000000000292","article-title":"The 2018 Chitranjan S. Ranawat, MD Award: developing and implementing a novel institutional guideline strategy reduced postoperative opioid prescribing After TKA and THA","volume":"477","author":"CC Wyles","year":"2019","journal-title":"Clin Orthop Relat Res"},{"issue":"12","key":"pone.0331335.ref030","article-title":"Standardized opioid prescription protocol reduces opioid consumption after total joint arthroplasty","volume":"3","author":"KM Vaz","year":"2019","journal-title":"J Am Acad Orthop Surg Glob Res Rev"},{"key":"pone.0331335.ref031","doi-asserted-by":"crossref","DOI":"10.1016\/j.arth.2019.02.022","article-title":"Restrictive opioid prescribing protocols following total hip arthroplasty and total knee arthroplasty are safe and effective","volume":"34","author":"AJ Holte","year":"2019","journal-title":"J Arthroplasty"},{"issue":"8","key":"pone.0331335.ref032","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0256741","article-title":"The potential for diversion of prescribed opioids among orthopaedic patients: Results of an anonymous patient survey","volume":"16","author":"K Sundararajan","year":"2021","journal-title":"PLoS One"},{"issue":"11","key":"pone.0331335.ref033","doi-asserted-by":"crossref","first-page":"953","DOI":"10.2106\/JBJS.19.01166","article-title":"Education increases disposal of unused opioids after total joint arthroplasty: a cluster-randomized controlled trial","volume":"102","author":"CR Nahhas","year":"2020","journal-title":"J Bone Joint Surg Am"},{"issue":"3","key":"pone.0331335.ref034","doi-asserted-by":"crossref","first-page":"987","DOI":"10.1007\/s40122-022-00409-6","article-title":"Prevalence of and risk factors for prescription opioid misuse, abuse, diversion and doctor shopping in Japan: a survey study","volume":"11","author":"T Takasusuki","year":"2022","journal-title":"Pain Ther"},{"key":"pone.0331335.ref035","doi-asserted-by":"crossref","DOI":"10.1136\/postgradmedj-2020-137957","article-title":"Patient expectations for opioid analgesia following orthopaedic surgery","volume":"98","author":"TM Spears","year":"2022","journal-title":"Postgrad Med J"},{"key":"pone.0331335.ref036","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1016\/j.jor.2020.01.020","article-title":"Effects of preoperative opioid education on postoperative opioid use and pain management in orthopaedics: a systematic review","volume":"20","author":"K Rucinski","year":"2020","journal-title":"J Orthop"},{"issue":"4","key":"pone.0331335.ref037","doi-asserted-by":"crossref","first-page":"790","DOI":"10.1016\/j.bja.2017.11.109","article-title":"Pain after orthopaedic surgery: differences in patient reported outcomes in the United States vs internationally. An observational study from the PAIN OUT dataset","volume":"120","author":"R Zaslansky","year":"2018","journal-title":"Br J Anaesth"},{"key":"pone.0331335.ref038","first-page":"1178221820930006","article-title":"Misuse of Tramadol in the United States: an analysis of the national survey of drug use and health 2002-2017","volume":"14","author":"SA Reines","year":"2020","journal-title":"Subst Abuse"},{"issue":"1","key":"pone.0331335.ref039","doi-asserted-by":"crossref","first-page":"3","DOI":"10.2174\/187447370801150611184218","article-title":"The misuse of prescription opioids: a threat for Europe?","volume":"8","author":"J van Amsterdam","year":"2015","journal-title":"Curr Drug Abuse Rev"},{"issue":"18","key":"pone.0331335.ref040","article-title":"Guideline for opioid therapy and chronic noncancer pain","volume":"189","author":"WB Jason","year":"2017","journal-title":"CMAJ"},{"key":"pone.0331335.ref041","volume-title":"COA position statement: opioids and orthopaedic surgical practice","year":"2018"},{"key":"pone.0331335.ref042","volume-title":"Safe prescribing of opioids and sedatives","author":"BotCoPa Surgeons","year":"2022"},{"issue":"3","key":"pone.0331335.ref043","doi-asserted-by":"crossref","first-page":"1","DOI":"10.15585\/mmwr.rr7103a1","article-title":"CDC clinical practice guideline for prescribing opioids for pain - United States, 2022","volume":"71","author":"D Dowell","year":"2022","journal-title":"MMWR Recomm Rep"},{"issue":"5","key":"pone.0331335.ref044","doi-asserted-by":"crossref","first-page":"949","DOI":"10.1002\/ejp.1736","article-title":"European* clinical practice recommendations on opioids for chronic noncancer pain - Part 1: Role of opioids in the management of chronic noncancer pain","volume":"25","author":"W H\u00e4user","year":"2021","journal-title":"Eur J Pain"},{"issue":"1","key":"pone.0331335.ref045","article-title":"Implementation of procedure-specific opioid guidelines: a readily employable strategy to improve consistency and decrease excessive prescribing following orthopaedic surgery","volume":"5","author":"CC Wyles","year":"2020","journal-title":"JB JS Open Access"},{"issue":"2","key":"pone.0331335.ref046","doi-asserted-by":"crossref","DOI":"10.1503\/cjs.008920","article-title":"Gender disparity in academic orthopedic programs in Canada: a cross-sectional study","volume":"65","author":"J Hunter","year":"2022","journal-title":"Can J Surg"},{"issue":"5","key":"pone.0331335.ref047","doi-asserted-by":"crossref","first-page":"783","DOI":"10.1177\/1049732319889354","article-title":"\u201cEverything is perfect, and we have no problems\u201d: detecting and limiting social desirability bias in qualitative research","volume":"30","author":"N Bergen","year":"2020","journal-title":"Qual Health Res"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0331335","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T17:40:34Z","timestamp":1756489234000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0331335"}},"subtitle":[],"editor":[{"given":"Miquel","family":"Vall-llosera Camps","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2025,8,29]]},"references-count":47,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2025,8,29]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0331335","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,29]]}}}