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A recent study conducted across nine Iowa hospitals has shown promising results in reducing postoperative opioid prescriptions by implementing Enhanced Recovery After Surgery (ERAS) pathways. The paper is published in the Journal of the American Academy of Orthopaedic Surgeons . The study, led by researchers from the Rothman Opioid Foundation, Goldfinch Health, and Drexel University College of Medicine, examined the impact of ERAS protocols on opioid prescribing to patients undergoing arthroplasty ( joint replacement surgery ) and arthroscopy (a minimally invasive procedure to diagnose and treat joint issues).
Arthroplasty involves replacing damaged joints with prosthetic implants to relieve pain and restore function, whereas arthroscopy utilizes a small camera to examine and repair joint damage through small incisions. "By leveraging ERAS pathways, which emphasize preoperative education, non-opioid pain management, and less invasive techniques, we found a significant decrease in opioid prescriptions," says Dr. Asif Ilyas, co-author of the study and President of the Rothman Institute Foundation for Opioid Research & Education and Professor of Orthopedic Surgery at Drexel University College of Medicine.
Arthroplasty patients experienced a 47% reduction, while arthroscopy patients saw a 33% decrease. Notably, arthroscopy patients had a higher percentage of unused opioids, highlighting the need for tailored strategies to minimize leftover medications. ERAS pathways are part of the "Billion Pill Pledge" program, which aims to reduce unnecessary opioid prescriptions and promote safer pain management practices, helping combat the opioid epidemic.
In 2022, Iowa became the first state to launch the Billion Pill Pledge program, an opioid first-dose prevention strategy led by Goldfinch Health. The Billion Pill Pledge program reduces unnecessary prescription opioid pills after surgery. This results in a lower risk of addiction, diversion, and accidental overdoses.
"By implementing these ERAS pathways, Iowa hospitals have demonstrated their commitment to safer pain management and reducing the risk of opioid misuse," says Ilyas. "Overall, the Billion Pill pathways show promise as a starting point to reduce excess postoperative opioid prescribing across orthopedics surgeries with the continued need for future studies." More information: Wali U.
Pirzada et al, Application and Analysis of the Enhanced Recovery After Surgery Opioid Prescription Protocol in Arthroscopy and Arthroplasty Patients, Journal of the American Academy of Orthopaedic Surgeons (2025). DOI: 10.5435/JAAOS-D-24-01232.
