Overprescription of pain medications directly fuels the opioid epidemic. Veterans are profoundly impacted. Tapered dose protocols may reduce excessive prescribing. A retrospective study of adult veterans who presented to our institution for primary total knee arthroplasty or total hip arthroplasty (THA) was performed. Postdischarge opioid use was reviewed before and after an opioid taper prescription protocol. The preprotocol and postprotocol groups had 299 and 89 veterans, respectively. Total Morphine Milligram Equivalent (MME) prescribed postdischarge, number of tablets prescribed, number of refills issued, 30-day emergency department visits, and 30-day readmissions were compared. Opioid naïve and chronic opioid users were both included. Preprotocol and postprotocol implementation group, in combination with surgery type (total knee arthroplasty versus THA) and opioid naïve status, predicted MME. On average, the postprotocol group received 224 MME less, THA patients received 177 MME less, and nonopioid naïve patients received 152 MME more. The opioid taper protocol led to less opioid administration after discharge. Taper protocols should be considered for postoperative pain management. III, retrospective comparison study.

中文翻译：

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住院全髋关节和膝关节置换术后阿片类药物剂量逐渐减少：质量改进研究和回顾性审查

止痛药的过量处方直接助长了阿片类药物的流行。退伍军人深受影响。逐渐减少剂量方案可以减少过度处方。对到我们机构进行初次全膝关节置换术或全髋关节置换术 (THA) 的成年退伍军人进行了一项回顾性研究。在阿片类药物逐渐减少处方方案之前和之后，对出院后阿片类药物的使用情况进行了审查。协议前和协议后组分别有 299 名和 89 名退伍军人。比较了出院后处方的总吗啡毫克当量 (MME)、处方药片数量、补充药物数量、30 天急诊科就诊和 30 天再入院情况。初次使用阿片类药物和长期使用阿片类药物的人都包括在内。方案前和方案后实施组结合手术类型（全膝关节置换术与 THA）和阿片类药物初次使用状态，预测了 MME。平均而言，治疗后组减少了 224 个 MME，THA 患者减少了 177 个 MME，未接受阿片类药物治疗的患者增加了 152 个 MME。阿片类药物逐渐减少方案导致出院后阿片类药物的给药量减少。术后疼痛管理应考虑逐渐减量方案。三、回顾性比较研究。