Exploration of Overdose Risk Score and Postoperative Complications and Health Care Use After Total Knee Arthroplasty

Abstract

IMPORTANCE The adverse outcomes after total knee arthroplasty (TKA) associated with preoperative prescription drug use (ie, use of narcotics, sedatives, and stimulants) have been established but are not well quantified. OBJECTIVE To test the association of preoperative overdose risk score (ORS) with postoperative health care use. DESIGN, SETTING, AND PARTICIPANTS This cohort study was conducted using data on a consecutive sample of individuals who underwent primary TKA from November 2018 through March 2020 at a tertiary care health system. Data were collected using the Orthopaedic Minimal Data Set Episode of Care, a validated data-collection system for all elective orthopedic surgical interventions taking place within the health care system. Outcomes were assessed at 90 days postoperatively. Individuals whose preoperative baseline characteristics or ORS were not provided or who declined to participate were excluded. Data were analyzed from September through October 2020. EXPOSURE Patient-specific preoperative ORS, as measured using NarxCare, associated with patterns of prescription drug use. MAIN OUTCOMES AND MEASURES Associations between patient-specific ORS categories and 90-day postoperative health care use (ie, prolonged hospital length of stay [LOS; ie, >2 days],nonhome discharge, all-cause 90-day readmission, emergency department [ED] visits, and reoperation) were evaluated. Outcomes were also compared between a group of individuals with ORS less than 300 vs those with ORS 300 or greater who were propensity score matched (4:1; caliper, 0.1) using demographic characteristics (ie, age, sex, race, body mass index, and smoking status) and baseline comorbidities.RESULTS Among 4326 individuals who underwent primary TKA, 2623 (60.63%) were women, 3602 individuals (83.26%) were White, the mean (SD) BMI was 32.8 (6.9), and the mean (SD) age was 66.6 (9.2) years; 90-day follow-up was available for the entire cohort. The predominant preoperative diagnosis was osteoarthritis, occurring among 4170 individuals (96.4%). For individuals with an ORS of 300 to 399, there were significantly higher odds of a prolonged LOS (odds ratio [OR],

Opioid and Sedative NarxCare Scores Greater Than 300 Are Associated with Adverse Outcomes After Non-Emergent Spine Surgery

“…This was performed for both sedative and opioid NCS individually. The 300-point cutoff was based on previous literature that demonstrated an association between increased healthcare utilization and adverse outcomes among joint arthroplasty patients with NCSs ≥300 versus <300 16,20. To evaluate for a similar association among nonemergent spine surgery patients, patients with NCS-opioids ≥300 were propensity score-matched (1:1) to a similar cohort of nonemergent spine surgery recipients with NCSs <300 (n=1031, each).…”

“…Of note, more recent investigations suggest an association between NCSs >300 and prolonged LOS ( i.e. , >2 d), nonhome discharge, 90-day readmission, and ED visits after primary elective total hip and knee arthroplasty 16,20. Therefore, the objective of the present analysis aimed to explore a potential association between preoperative drug-specific NCS and adverse outcomes after nonemergent spine surgery using an extensive prospective institutional cohort.…”

“…Of note, more recent investigations suggest an association between NCSs > 300 and prolonged LOS (i.e., > 2 d), nonhome discharge, 90-day readmission, and ED visits after primary elective total hip and knee arthroplasty. 16,20 Therefore, the objective of the present analysis aimed to explore a potential association between preoperative drug-specific NCS and adverse outcomes after nonemergent spine surgery using an extensive prospective institutional cohort. Specifically, we aimed to explore a potential association between the preoperative opioid-specific NCS (NCS-opioids) as well as sedative-specific NCS (NCS-sedatives) as a measure of patients' prescription drug use and (1) 90-day postoperative readmissions; (2) ED visits; (3) reoperation; (4) prolonged ( > 2 d) hospital LOS; and (5) nonhome discharge disposition.…”

Determining the Association of Preoperative Controlled Prescription Medication Use With Outcomes After Total Knee Arthroplasty

“…This includes information on medications prescribed, dose and duration of each prescription, date of prescription(s), prescriber(s), and pharmacy. The study by Emara et al uses NarxCare, an overdose risk score (ORS) was developed to aggregate these measures into a composite score to aid prescribers and pharmacists in identifying abuse potential in patients receiving controlled substances.…”

“…They also ignore the potential influence of the combination of multiple controlled medications. The ORS, and consequently the study by Emara et al, 2 were able to overcome these deficiencies by combining a complex composite of information into a simple and clinically useful score.…”