Lindsey Wurster and Sarah Brandt are Physician Assistants, Patricia Mecum is a Family Nurse Practitioner, Kenneth Gundle and Lucas Anissian are Attending Orthopedic Surgeons, all at US Department of Veterans Affairs Portland Health Care System in Oregon. Erik Woelber is an Orthopedic Surgery Resident, and Kenneth Gundle is an Attending Physician, both in the Orthopedic Department at Oregon Health and Sciences University in Portland. Correspondence: Lindsey Wurster (lindsey.wurster@va.gov)
Author disclosures The authors report no actual or potential conflicts of interest with regard to this article.
Disclaimer The opinions expressed herein are those of the authors and do not necessarily reflect those of Federal Practitioner, Frontline Medical Communications Inc., the US Government, or any of its agencies. This article may discuss unlabeled or investigational use of certain drugs. Please review the complete prescribing information for specific drugs or drug combinations—including indications, contraindications, warnings, and adverse effects—before administering pharmacologic therapy to patients.
These limitations are balanced by several strengths. Our cohort was well controlled with respect to the dose and type of drug used. There is staff dedicated to postoperative telephone follow-up after discharge, and veterans are apt to seek care within the VA health care system, which improves case finding for complications and ED visits. No patients were lost to follow-up. Moreover, our drastic reduction in opioid use is promising enough to warrant reporting, while the broader orthopedic literature explores the relative impact of each variable.
Conclusions
The MOJO protocol has been effective for reducing postoperative opioid use after TKA without compromising effective pain management. The drastic reduction in the postoperative use of opioid pain medications and LOS have contributed to a cultural shift within our department, comprehensive team approach, multimodal pain management, and preoperative patient optimization. Further investigations are required to assess the impact of each intervention on observed outcomes. However, the framework and routines are applicable to other institutions and surgical specialties.
Acknowledgments
The authors recognize Derek Bond, MD, for his help in creating the MOJO acronym.
