A survey has uncovered wide variability in how orthopedic surgeons interpret their patients’ postoperative opioid consumption after total knee arthroplasty (TKA).
I find it odd that the leading sentence of this article talks about the “interpretation” (not estimate) of their patients’ postoperative opioid “consumption” (not need).
the researchers surveyed 36 orthopedic surgery residents, fellows and attendings at the institution. Respondents were asked to estimate the percentage of patients using opioids in the month before undergoing their TKA, as well as one to three months postoperatively.
It seems nonsensical to ask a doctor what percentage of patients were using opioids before a surgery they performed when they may not have been that patient’s doctor previously.
Patients who were on opioid maintenance therapy were excluded from the analysis.
I don’t see how they differentiated “opioid maintenance therapy” from “the percentage of patients using opioids in the month before”.
This kind of convoluted “reasoning” is typical of opioid studies because the straight data too often points to the effectiveness of opioids and lack of harm. Therefore, researchers find strangely staged scenarios and establish all kinds of obscure criteria to find a way to collect data that will make opioids look like a bad option.
Estimates Accurate on Average, But Disparate
These answers were then compared with data from 189 adult patients (mean age, 69.9±10.1 years) who underwent primary TKA at the institution over an eight-month period, from 2017 to 2018. Demographic data were extracted from electronic health records, whereas opioid prescription data came from the CURES database.
Patients’ mean ASA physical status was 2.6±0.5; they consumed a mean of 165.0±180.8 morphine milligram equivalents during their inpatient stay.
This is statistical nonsense. The standard deviation/amount of variation (180mg) is greater than the average dose (165mg). This means there was so much variation in the data that “averages” are meaningless.
As the Table illustrates, surgeons’ mean estimates of patient opioid consumption tracked closely with actual postoperative opioid prescription fills, which the researchers used as a surrogate for opioid consumption.
Table: Patient Opioid Consumption Over Time Surgeons’ Estimates Actual Use Within 30 days of surgery, % 23.5±18.9 14.8 One month after surgery, % 53.6±23.9 51.3 Two months after surgery, % 23.7±12.4 22.75 Three months after surgery, % 12.5±7.7 16.4
Yet as accurate as the surgeons may have been on average, the investigators were surprised by the wide variation in their responses.
It seems these researchers know nothing about individualized medicine, which is now actively promoted and pursued by the National Institute of Health, most cancer centers, and the most expensive pharmaceuticals.
“If you look at the data point scatterplot, they’re all over the place,” Dr. Lii told Pain Medicine News (Figure).
Yes, and that’s as it should be due or the amount of individual variation in our current health status, past history with opioids, age, occupation, and the rest of the zillions of differences between us.
“You have some surgeons who believe that none of their patients need opioids and subsequently estimate very low numbers of patients who use opioids. And then, some surgeons think their patients are in pain all the time and all of them need opioids.”
More Education Needed
No amount of book learning can trump personal experience. The best possible, and perhaps the only way for anyone to understand pain is to have it themselves.