PT - JOURNAL ARTICLE AU - Michael J Buys AU - Kimberlee Bayless AU - Jennifer Romesser AU - Zachary Anderson AU - Shardool Patel AU - Chong Zhang AU - Angela P Presson AU - Benjamin S Brooke TI - Opioid use among veterans undergoing major joint surgery managed by a multidisciplinary transitional pain service AID - 10.1136/rapm-2020-101797 DP - 2020 Nov 01 TA - Regional Anesthesia & Pain Medicine PG - 847--852 VI - 45 IP - 11 4099 - http://rapm.bmj.com/content/45/11/847.short 4100 - http://rapm.bmj.com/content/45/11/847.full SO - Reg Anesth Pain Med2020 Nov 01; 45 AB - Background Chronic postsurgical pain and opioid use is a problem among patients undergoing many types of surgical procedures. A multidisciplinary approach to perioperative pain management known as a transitional pain service (TPS) may lower these risks.Methods This retrospective cohort study was conducted at the Salt Lake City VA Medical Center to compare patients undergoing elective primary or revision total knee, hip, or shoulder replacement or rotator cuff repair in the year before (2017) and after (2018) implementation of a TPS. The primary outcome is the proportion of patients taking opioids 90 days after surgery. Secondary outcomes include new chronic opioid use (COU) after surgery as well as the proportion of previous chronic opioid users who stopped or decreased opioid use after surgery.Results At 90 days after surgery, patients enrolled in TPS were significantly less likely to be taking opioids (13.4% TPS vs 27.3% pre-TPS; p=0.002). This relationship remained statistically significant in a multivariable logistic regression analysis, where the TPS group had 69% lower odds of postoperative COU compared with the preintervention group (OR: 0.31; 95% CI: 0.14 to 0.66; p=0.03). Opioid-naive patients enrolled in TPS were less likely to have new COU after surgery (0.7% TPS vs 8.4% pre-TPS; p=0.004). Further, patients enrolled in TPS with existing COU prior to surgery were more likely to reduce or completely stop opioid use after surgery (67.5% TPS vs 45.3% pre-TPS; p=0.037) as compared with pre-TPS.Conclusions These data suggest that a TPS is an effective strategy for preventing new COU and reducing overall opioid use following orthopedic joint procedures in a Veterans Affairs hospital.