How Do Preoperative Medications Influence Outcomes After Total Joint Arthroplasty?

Zarling, Bradley J.; Sikora‐Klak, Jakub; Bergum, Chris; Markel, David C.

doi:10.1016/j.arth.2017.04.031

Cited by 26 publications

(8 citation statements)

References 24 publications

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“…Subsequent subgroup analysis of patients with diabetes revealed that compared to those who were only on oral hypoglycaemic agents (OHGAs), those who were on insulin tended to be predisposed to poorer outcomes of postoperative hyperglycaemia (93.4% vs 87.0%, p < 0.001), AKI (49.0% vs 36.3%, p < 0.001), new need for dialysis (10.2% vs 3.7%, p < 0.001), ICU mortality (3.1% vs 0.9%, p = 0.006), and longer hospitalisation stay (15.3% vs 11.8%, p < 0.001). Zarling et al 24 also showed that patients on insulin therapy tended to be 1.89 times more likely to require Discharge to an Extended-Care Facility after surgery, corroborating our results that patients with diabetes who are on insulin therapy are more likely to have poorer outcome and more postoperative complications than their counterparts who have not been started on regular insulin regimes.…”

Section: Discussionsupporting

confidence: 90%

Impact of diabetes on outcomes of cardiac surgery in a multiethnic Southeast Asian population

Moorthy

Liu

Chew

et al. 2019

Diabetes and Vascular Disease Research

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Although diabetes is rapidly increasing in Asia and has been shown to be associated with worse cardiac surgery outcomes, no research has been done to study the impact of diabetes on cardiac surgery outcomes in a Southeast Asian cohort. Hence, this study aims to delineate the predictors and impact of diabetes after cardiac surgery in a multi-ethnic Southeast Asian cohort. We analysed data from 2831 adult patients undergoing elective cardiac surgery, from 2008 to 2010 in Singapore. Diabetes was found to significantly increase the odds of intensive care unit readmission by 1.70 (95% confidence interval 1.171–2.480, p = 0.005), postoperative infection by 1.73 (95% confidence interval 1.003–2.976, p = 0.049), acute kidney injury by 1.36 (95% confidence interval 1.137–1.626, p = 0.001), postoperative hyperglycaemia by 6.00 (95% confidence interval 4.893–7.348, p < 0.001), and new need for dialysis by 1.71 (95% 1.086–5.360, p = 0.021). In conclusion, diabetes is associated with increased risk for renal dysfunction, hyperglycaemia, and infection after cardiac surgery, similar to the relative risks of diabetes patients observed in Western populations.

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Section: Discussionsupporting

confidence: 90%

Impact of diabetes on outcomes of cardiac surgery in a multiethnic Southeast Asian population

Moorthy

Liu

Chew

et al. 2019

Diabetes and Vascular Disease Research

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“…For arthroplasty specifically, narcotics were one of the two most notable preoperative medication classes in lengthening inpatient stays, complications and readmissions rates with diabetic medication being the second. 12,13 It is of clinical importance to gain additional understanding of its potential negative effect on postoperative outcomes. In this study, we found that although both opioid users and nonusers demonstrated improvement in PROMs after surgery, preoperative opioid use among patients with THA was more likely to be associated with lower preoperative and postoperative PROMs, longer hospital stays, and higher rates of discharge to rehabilitation facility rather than home.…”

Section: Discussionmentioning

confidence: 99%

Preoperative Opioid Use Negatively Affects Patient-reported Outcomes After Primary Total Hip Arthroplasty

Bonner

Castillo

Fitz

et al. 2019

J Am Acad Orthop Surg

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Background: Opioid use is a public health crisis in the United States and an area of increased focus in orthopaedic surgery. The aim of this study is to investigate whether preoperative opioid use had any effect on patient-reported outcome measures (PROMs) before and after total hip arthroplasty (THA). Methods: A total of 389 patients with THA with both preoperative and postoperative PROMs were reviewed: (1) 76 patients with preoperative opioid use (24%) and (2) 237 patients without preoperative opioid use (76%). Patient demographics and clinical information including opioid use, length of stay, and implant information.Results: Preoperative opioid users were more likely to stay in the hospital longer (P = 0.004) and be discharged to a rehabilitation facility (P = 0.038). Postoperatively, the Physical Function Short Form 10a (P = 0.021) and Patient-Reported Outcomes Measurement Information System Global-10 (P , 0.001 physical, P = 0.001, mental) were significantly lower in the preoperative opioid users. Within groups, both nonusers and preoperative opioid users saw improvements after THA in Hip Disability and Osteoarthritis Outcome Score-Physical Function Short Form (P , 0.001), Short Form 10a (P , 0.001), and Patient-Reported Outcomes Measurement Information System Global-10 (P , 0.001, physical and P = 0.008, mental). Discussion: Although all patients reported improvements after THA regardless of preoperative opioid use, preoperative opioid users undergoing THA had significantly lower patient-reported outcome scores, longer hospital stays, and a more likely discharge to rehabilitation.B eginning with the initiation of the American Pain Society "Pain, The Fifth Vital Sign" campaign in the 1990s and the subsequent mandate by the Joint Commission on the Accreditation of Healthcare Organizations to provide pain assessment and treatment for all patients in ac-credited healthcare settings, an opioid epidemic has risen in the United States. 1 Opioid use is the leading cause of accidental death in the United States, and more than 2.4 million Americans have a severe opioid use disorder. 2 Consequently, increasing focus has been placed on

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“…Jain et al [3] evaluated 58,082 patients undergoing TJA or posterior lumbar fusion and found a significantly increased 90-day ED visit and readmission risk with continuous opioid prescriptions for longer than 6 months prior to surgery. Similarly, in a cohort of 3959 patients who underwent arthroplasty, Zarling et al [19] found that preoperative opioid use increased length of stay and readmission rates. In this current study, patients prescribed <5 MME daily had significantly increased interactions with the healthcare system in the early postoperative period, demonstrating that even small doses of preoperative opioids have significant effects.…”

Section: Discussionmentioning

confidence: 94%

Preoperative Opioids and the Dose-Dependent Effect on Outcomes After Total Hip Arthroplasty

Terhune

Hannon

Burnett

et al. 2022

The Journal of Arthroplasty

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How Do Preoperative Medications Influence Outcomes After Total Joint Arthroplasty?

Cited by 26 publications

References 24 publications

Impact of diabetes on outcomes of cardiac surgery in a multiethnic Southeast Asian population

Impact of diabetes on outcomes of cardiac surgery in a multiethnic Southeast Asian population

Preoperative Opioid Use Negatively Affects Patient-reported Outcomes After Primary Total Hip Arthroplasty

Preoperative Opioids and the Dose-Dependent Effect on Outcomes After Total Hip Arthroplasty

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