Evidence map›Paper›PMID 40533253›Full record

ArticleCanadian journal of surgery. Journal canadien de chirurgie

Changes in opioid distribution and chronic opioid users following outpatient orthopedic surgery: a pre-post intervention study.

Riley Hemstock, Sheila McRae, Ian Laxdal, Thomas Mutter, Kevin Friesen, Heather J Prior, Jason Old, Gregory Stranges, Devin Lemmex, James Dubberley and 4 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Canadian journal of surgery. Journal canadien de chirurgie. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors.

Riley HemstockFrom the Department of Surgery, Orthopaedic Section, University of Manitoba, Winnipeg, Man. (Hemstock, McRae, Laxdal, Old, Stranges, Lemmex, Dubberley, Marsh, Longstaffe, MacDonald, Woodmass); the Pan Am Clinic Foundation, Winnipeg, Man. (McRae); the Pan Am Clinic, Winnipeg, Man. (Old, Stranges, Lemmex, Dubberley, Marsh, Longstaffe, MacDonald, Woodmass); the Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, Man. (Mutter); the Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Man. (Friesen, Prior).
Sheila McRaeFrom the Department of Surgery, Orthopaedic Section, University of Manitoba, Winnipeg, Man. (Hemstock, McRae, Laxdal, Old, Stranges, Lemmex, Dubberley, Marsh, Longstaffe, MacDonald, Woodmass); the Pan Am Clinic Foundation, Winnipeg, Man. (McRae); the Pan Am Clinic, Winnipeg, Man. (Old, Stranges, Lemmex, Dubberley, Marsh, Longstaffe, MacDonald, Woodmass); the Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, Man. (Mutter); the Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Man. (Friesen, Prior).
Ian LaxdalFrom the Department of Surgery, Orthopaedic Section, University of Manitoba, Winnipeg, Man. (Hemstock, McRae, Laxdal, Old, Stranges, Lemmex, Dubberley, Marsh, Longstaffe, MacDonald, Woodmass); the Pan Am Clinic Foundation, Winnipeg, Man. (McRae); the Pan Am Clinic, Winnipeg, Man. (Old, Stranges, Lemmex, Dubberley, Marsh, Longstaffe, MacDonald, Woodmass); the Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, Man. (Mutter); the Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Man. (Friesen, Prior).
Thomas MutterFrom the Department of Surgery, Orthopaedic Section, University of Manitoba, Winnipeg, Man. (Hemstock, McRae, Laxdal, Old, Stranges, Lemmex, Dubberley, Marsh, Longstaffe, MacDonald, Woodmass); the Pan Am Clinic Foundation, Winnipeg, Man. (McRae); the Pan Am Clinic, Winnipeg, Man. (Old, Stranges, Lemmex, Dubberley, Marsh, Longstaffe, MacDonald, Woodmass); the Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, Man. (Mutter); the Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Man. (Friesen, Prior).
Kevin FriesenFrom the Department of Surgery, Orthopaedic Section, University of Manitoba, Winnipeg, Man. (Hemstock, McRae, Laxdal, Old, Stranges, Lemmex, Dubberley, Marsh, Longstaffe, MacDonald, Woodmass); the Pan Am Clinic Foundation, Winnipeg, Man. (McRae); the Pan Am Clinic, Winnipeg, Man. (Old, Stranges, Lemmex, Dubberley, Marsh, Longstaffe, MacDonald, Woodmass); the Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, Man. (Mutter); the Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Man. (Friesen, Prior).
Heather J PriorFrom the Department of Surgery, Orthopaedic Section, University of Manitoba, Winnipeg, Man. (Hemstock, McRae, Laxdal, Old, Stranges, Lemmex, Dubberley, Marsh, Longstaffe, MacDonald, Woodmass); the Pan Am Clinic Foundation, Winnipeg, Man. (McRae); the Pan Am Clinic, Winnipeg, Man. (Old, Stranges, Lemmex, Dubberley, Marsh, Longstaffe, MacDonald, Woodmass); the Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, Man. (Mutter); the Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Man. (Friesen, Prior).
Jason OldFrom the Department of Surgery, Orthopaedic Section, University of Manitoba, Winnipeg, Man. (Hemstock, McRae, Laxdal, Old, Stranges, Lemmex, Dubberley, Marsh, Longstaffe, MacDonald, Woodmass); the Pan Am Clinic Foundation, Winnipeg, Man. (McRae); the Pan Am Clinic, Winnipeg, Man. (Old, Stranges, Lemmex, Dubberley, Marsh, Longstaffe, MacDonald, Woodmass); the Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, Man. (Mutter); the Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Man. (Friesen, Prior).
Gregory StrangesFrom the Department of Surgery, Orthopaedic Section, University of Manitoba, Winnipeg, Man. (Hemstock, McRae, Laxdal, Old, Stranges, Lemmex, Dubberley, Marsh, Longstaffe, MacDonald, Woodmass); the Pan Am Clinic Foundation, Winnipeg, Man. (McRae); the Pan Am Clinic, Winnipeg, Man. (Old, Stranges, Lemmex, Dubberley, Marsh, Longstaffe, MacDonald, Woodmass); the Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, Man. (Mutter); the Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Man. (Friesen, Prior).
Devin LemmexFrom the Department of Surgery, Orthopaedic Section, University of Manitoba, Winnipeg, Man. (Hemstock, McRae, Laxdal, Old, Stranges, Lemmex, Dubberley, Marsh, Longstaffe, MacDonald, Woodmass); the Pan Am Clinic Foundation, Winnipeg, Man. (McRae); the Pan Am Clinic, Winnipeg, Man. (Old, Stranges, Lemmex, Dubberley, Marsh, Longstaffe, MacDonald, Woodmass); the Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, Man. (Mutter); the Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Man. (Friesen, Prior).
James DubberleyFrom the Department of Surgery, Orthopaedic Section, University of Manitoba, Winnipeg, Man. (Hemstock, McRae, Laxdal, Old, Stranges, Lemmex, Dubberley, Marsh, Longstaffe, MacDonald, Woodmass); the Pan Am Clinic Foundation, Winnipeg, Man. (McRae); the Pan Am Clinic, Winnipeg, Man. (Old, Stranges, Lemmex, Dubberley, Marsh, Longstaffe, MacDonald, Woodmass); the Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, Man. (Mutter); the Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Man. (Friesen, Prior).
Jonathan MarshFrom the Department of Surgery, Orthopaedic Section, University of Manitoba, Winnipeg, Man. (Hemstock, McRae, Laxdal, Old, Stranges, Lemmex, Dubberley, Marsh, Longstaffe, MacDonald, Woodmass); the Pan Am Clinic Foundation, Winnipeg, Man. (McRae); the Pan Am Clinic, Winnipeg, Man. (Old, Stranges, Lemmex, Dubberley, Marsh, Longstaffe, MacDonald, Woodmass); the Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, Man. (Mutter); the Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Man. (Friesen, Prior).
Robert LongstaffeFrom the Department of Surgery, Orthopaedic Section, University of Manitoba, Winnipeg, Man. (Hemstock, McRae, Laxdal, Old, Stranges, Lemmex, Dubberley, Marsh, Longstaffe, MacDonald, Woodmass); the Pan Am Clinic Foundation, Winnipeg, Man. (McRae); the Pan Am Clinic, Winnipeg, Man. (Old, Stranges, Lemmex, Dubberley, Marsh, Longstaffe, MacDonald, Woodmass); the Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, Man. (Mutter); the Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Man. (Friesen, Prior).
Peter MacDonaldFrom the Department of Surgery, Orthopaedic Section, University of Manitoba, Winnipeg, Man. (Hemstock, McRae, Laxdal, Old, Stranges, Lemmex, Dubberley, Marsh, Longstaffe, MacDonald, Woodmass); the Pan Am Clinic Foundation, Winnipeg, Man. (McRae); the Pan Am Clinic, Winnipeg, Man. (Old, Stranges, Lemmex, Dubberley, Marsh, Longstaffe, MacDonald, Woodmass); the Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, Man. (Mutter); the Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Man. (Friesen, Prior).
Jarret WoodmassFrom the Department of Surgery, Orthopaedic Section, University of Manitoba, Winnipeg, Man. (Hemstock, McRae, Laxdal, Old, Stranges, Lemmex, Dubberley, Marsh, Longstaffe, MacDonald, Woodmass); the Pan Am Clinic Foundation, Winnipeg, Man. (McRae); the Pan Am Clinic, Winnipeg, Man. (Old, Stranges, Lemmex, Dubberley, Marsh, Longstaffe, MacDonald, Woodmass); the Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, Man. (Mutter); the Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Man. (Friesen, Prior) jwoodmass@panamclinic.com.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundOutpatient overprescribing of opioids in the postoperative period contributes to the opioid epidemic. Given that patient education and evidence-informed prescription protocols have reduced postoperative opioid use in small, randomized trials, we sought to evaluate the effectiveness of a multimodal opioid reduction protocol, implemented institution-wide at an outpatient Canadian orthopedic surgery centre.

methodsIn this pre-post intervention study, we used deidentified health administrative data from a provincial data repository to identify all opioid-naive patients who underwent outpatient shoulder or knee surgery at a single institution between 2013 and 2022. An opioid restriction protocol was implemented in 2019, including an educational pamphlet, perioperative verbal education, and a standardized postoperative analgesic prescription. Outcomes analyzed included dispensed morphine milligram equivalents (MME) per patient within 180 days of surgery and chronic opioid use, defined as opioids dispensed 180-270 days after surgery. Prescriptions dispensed from any provider were included.

resultsWe included 8244 patients preintervention and 2205 patients postintervention in the analyses. The average MME dispensed per patient decreased by 18% (57.8 MME, 95% confidence interval 45.0-70.6). The proportion of patients who filled opioid prescriptions beyond 180 days after surgery decreased from 4.8% to 2.6% (

conclusionThe volume of opioids dispensed and the number of chronic opioid users were significantly reduced among patients who underwent outpatient orthopedic surgery after the institution-wide implementation of a multimodal postoperative opioid reduction protocol.

Indexed as

Ambulatory Surgical ProceduresAnalgesics, OpioidOpioid-Related DisordersOrthopedic ProceduresPostoperative PainPractice Patterns, Physicians'AdultAgedCanadaFemaleHumansMaleMiddle AgedAnalgesics, Opioid

Identifiers

PMID40533253
PMCPMC12180918

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.