Does Preoperative Opioid Consumption Increase the Risk of Chronic Postoperative Opioid Use After Total Joint Arthroplasty?

Abstract

Background: Risk-factor identification related to chronic opioid use after surgery may facilitate interventions mitigating postoperative opioid consumption. We evaluated the relationship between opioid use preceding total hip arthroplasty (THA) and total knee arthroplasty (TKA), and chronic use postoperatively, and the risk of chronic opioid use after total joint arthroplasty. Methods: All primary THAs and TKAs performed during a 6-month period were identified. Opioid prescription and utilization data (in oxycodone equivalents) were determined via survey and electronic records. Relationship between preoperative opioid use and continued use >90 days after surgery was assessed via Chi-square, with significance set at P < .05. Results: A total of 415 patients met inclusion criteria (240 THAs and 175 TKAs). Of the 240 THAs, 199 (82.9%) patients and of the 175 TKAs, 144 (82.3%) patients agreed to participate. Forty-three of 199 (21.6%) THA patients and 22 of 144 (15.3%) TKA patients used opioids within 30 days preoperatively. Nine of 199 (4.5%) THA and 10 of 144 (6.9%) TKA patients had continued use of opioids for >90 days postoperatively. Preoperative opioid consumption was significantly associated with chronic use postoperatively for THA (P ¼ .011) and TKA (P ¼ .024). Five of 43 (11.6%) THA and 4 of 22 (18.2%) TKA patients with preoperative opioid use had continued use for >90 days postoperatively. For opioid naïve patients, 2.6% (4/156) of THA and 4.9% (6/122) of TKA patients had chronic use postoperatively. Conclusions: Preoperative opioid use was associated with nearly 5-fold and 4-fold increase in percentage of patients with chronic opioid use after THA and TKA, respectively. Surgeons should counsel patients regarding this risk and consider strategies to eliminate preoperative opioid use.

Opioid prescriptions after knee replacement: a retrospective study of pathways and prognostic factors in the Swiss healthcare setting

“…Despite the small proportion of patients with chronic episodes, the total number remains noticeable. Chronic opioid use after KR has also been documented in previous studies 37 39 53. Regarding opioid dosage, another Swiss study found lower maximum daily MED of non-cancer opioid applications compared with our calculated dosages 59.…”

“…Another explanation may be a result of recommendations to detect and discontinue potentially inappropriate prescriptions specifically targeting this demographic population 78 79. Use of preoperative analgesics was a predictor of postoperative opioids, with preoperative opioid use being the strongest predictor, and is in line with numerous previous findings 9 37–44. Using analgesics might be associated with a higher prevalence of pain, increased pain sensitivity or opioid tolerance 80 81.…”

“…Although our study reports different opioid rates compared with prior studies, specifications (eg, definition of observation period and OU) may have influenced the reported proportions, in combination with possible different provider-specific and geography-specific prescribing practices 9 51–53. Studies that used comparable definitions of preoperative37 54 and postoperative opioid use55 reported only a marginally lower overall preoperative (by 4% and 15%, respectively) and a slightly higher (by 8%) postoperative rate of opioid use. In comparison to a Swiss study, we found a higher degree of acute opioid use and a lower degree of chronic opioid use 25.…”

“…Therefore, we included utilisation of services in physical therapy, acupuncture and medication (non-opioids) for pain management 1 year before the KR intervention. Because a large strand of literature demonstrated the correlation between preoperative and postoperative opioids,9 37–46 we also included the presence of preoperative (12 months preceding KR) opioid prescriptions as an explanatory variable.…”

Team Approach: Use of Opioids in Orthopaedic Practice

“…Preoperative At-Risk Patient Identification: Screening for Opioids Many investigators have focused on identifying risk factors for prolonged use of opioids after orthopaedic surgery [26][27][28] . Preoperative opioid consumption has been identified as a major risk factor of chronic opioid use after orthopaedic surgery [29][30][31][32][33] . Conditions such as chronic pain syndrome, back pain, fibromyalgia, chronic fatigue, and sleep disorders are also associated with prolonged use of opioids after surgery 34 .…”