Site of Service Changes Have Resulted in Increased Opioid Prescriptions for Primary Total Hip and Knee Patients in Michigan, a Michigan Arthroplasty Registry Collaborative Quality Initiative Quality Study.

Background: The Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI) successfully changed opioid prescribing patterns by instituting guidelines for total hip (THAs) and knee arthroplasties (TKAs). Given Medicare changes, cases are moving to ambulatory surgery centers (ASCs) and hospital outpatient departments (HOPDs). We aimed to assess whether these sites adopted the well-proven opioid recommendations.

Methods: Using data from the Michigan Arthroplasty Registry Collaborative Quality Initiative, all opioid-naïve (no prescription within 30 days) patients undergoing primary total joint arthroplasty between July 1, 2021, and June 30, 2022, were identified. Of the 12,962 THAs: 11.0% (1425) were in ASCs, 5.2% (674) in HOPDs, and 84% (10,863) in hospitals. Of the 20,092 primary TKAs: 10.3% (2064) were in ASCs, 4.5% (906) in HOPDs, and 85.2% (17,122) in hospitals.

Results: The cohorts were statistically different, with unhealthier patients within the hospital population. For THAs and TKAs, ASCs had the highest mean oral morphine equivalents at discharge, 239 (±109.9) and 307.4 (±151.9), compared to hospitals and HOPDs ( < .05). Overall, HOPDs had the lowest oral morphine equivalent for THA ( < .05), while HOPDs and Hospitals had similar levels for TKAs ( = .27). ASCs had the lowest compliance rate for both THA (56%) and TKA(69%) compared to HOPDs (89%, 80%) and hospitals (83%, 87%) ( < .05), respectively.

Conclusions: ASC and HOPDs patients are selected for the ability to be discharged home. Yet opioid-naïve total joint arthroplasty patients at Michigan ASCs received more opioids at discharge compared to patients undergoing the same procedures at HOPDs and hospitals.