Impact of Preoperative Opioid Use on Total Knee Arthroplasty Outcomes

Smith, Savannah; Bido, Jennifer; Collins, Jamie E.; Yang, Henry C.; Katz, Jeffrey N.; Losina, Elena

doi:10.2106/jbjs.16.01200

Cited by 174 publications

(123 citation statements)

References 23 publications

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“…Pain after primary TKA can be substantial and has been shown to increase continued opioid use and dependence in previously opioid-naïve [24] and opioid-experienced [25,26] M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT 9 patients. Several studies have observed that tourniquets result in greater pain in the immediate postoperative period, [7][8][9][10][11][12] with two of those studies [7,12] showing increased analgesia consumption as a result and one showing no differences in analgesia consumption.…”

Section: Discussionmentioning

confidence: 99%

Tourniquetless Total Knee Arthroplasty With Modern Perioperative Protocols Decreases Pain and Opioid Consumption in Women

Kheir

Ziemba-Davis

Dilley

et al. 2018

The Journal of Arthroplasty

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Section: Discussionmentioning

confidence: 99%

Tourniquetless Total Knee Arthroplasty With Modern Perioperative Protocols Decreases Pain and Opioid Consumption in Women

Kheir

Ziemba-Davis

Dilley

et al. 2018

The Journal of Arthroplasty

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“…Compared with total hip arthroplasty patients, TKA patients were twice as likely to require refill opioid prescriptions and were prescribed a greater total morphine equivalent dose for a longer period of time postoperatively. Increasing evidence reveals that preoperative chronic use of opioids reduces the effect of pain relief postoperation, and increases postoperative opioid consumption in TKA patients. In addition, preoperative opioid use is associated with early revision, postoperative complications, worse clinical outcomes due to developed tolerance, and hyperalgesia, which can complicate recovery and rehabilitation.…”

Section: Preoperative Analgesic Regimensmentioning

confidence: 99%

Postoperative Pain Management in Total Knee Arthroplasty

Xiao

2019

Orthopaedic Surgery

222

165

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Total knee arthroplasty (TKA) is one of the most common surgeries performed to relieve joint pain in patients with end‐stage osteoarthritis or rheumatic arthritis of the knee. However, TKA is followed by moderate to severe postoperative pain that affects postoperative rehabilitation, patient satisfaction, and overall outcomes. Historically, opioids have been widely used for perioperative pain management of TKA. However, opioids are associated with undesirable adverse effects, such as nausea, respiratory depression, and retention of urine, which limit their application in daily clinical practice. The aim of this review was to discuss the current postoperative pain management regimens for TKA. Our review of the literature demonstrated that multimodal analgesia is considered the optimal regimen for perioperative pain management of TKA and improves clinical outcomes and patient satisfaction, through a combination of several types of medications and delivery routes, including preemptive analgesia, neuraxial anesthesia, peripheral nerve blockade, patient‐controlled analgesia and local infiltration analgesia, and oral opioid/nonopioid medications. Multimodal analgesia provides superior pain relief, promotes recovery of the knee, and reduces opioid consumption and related adverse effects in patients undergoing TKA.

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“…In the adult reconstruction realm, prior research has demonstrated that patients prescribed preoperative opioids are at higher risk for perioperative morbidity, revision, and less satisfactory outcomes [4][5][6][7][8][9][10][11]. Much attention has also been paid to postoperative opioid regimens, and there has been increasing recognition that conservative postoperative prescription patterns of opioids can be both safe and effective [12].…”

Section: Introductionmentioning

confidence: 99%

The Impact of Preoperative Opioid Use Disorder on Complications and Costs following Primary Total Hip and Knee Arthroplasty

Wilson

Farley

Aizpuru

et al. 2019

Advances in Orthopedics

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Introduction. Multiple studies have demonstrated that patients taking opioids in the preoperative period are at elevated risk for complications following total hip (THA) and knee (TKA) arthroplasty. However, the incidence and impact of opioid use disorder (OUD) among these patients—both clinically and fiscally—remain unknown. The purpose of this study was to investigate this relationship. Methods. The Nationwide Readmission Database (NRD) was used to identify patients undergoing THA and TKA from 2011 to 2015. Coarsened exact matching was used to statistically match the OUD and non-OUD cohorts. Further analysis was then conducted on matched cohorts with multivariate analysis. The incidence of OUD was also determined, and the costs associated with this comorbidity were calculated. Results. The incidence of OUD in arthroplasty patients increased 80% over the study period. OUD patients had higher odds of prosthetic joint infection (OR 1.55, 95% CI 1.23–1.94), wound complication (OR 1.40, 95% CI 1.12–1.76), prosthetic complication (OR 1.37, 95% CI 1.10–1.70), and revision surgery (OR 1.47, 95% CI 1.19–1.81). OUD patients also had longer length of stays (TKA: +0.67 days; THA: +1.09 days), higher readmission (OR 1.60, 95% CI 1.43–1.79), and increased 90-day costs (TKA: +$3,602 [95% CI $3,138–4,065]; THA: +4,527 [95% CI $3,593–4,920). Conclusion. Opioid use disorder is becoming a more common comorbidity among THA and TKA patients. This is concerning as it represents a significant risk factor for postoperative complication. It additionally confers increased perioperative costs. Patients with OUD should be counseled on their elevated risk, and future work will be needed to determine if this is a modifiable risk factor.

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Impact of Preoperative Opioid Use on Total Knee Arthroplasty Outcomes

Abstract: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Cited by 174 publications

References 23 publications

Tourniquetless Total Knee Arthroplasty With Modern Perioperative Protocols Decreases Pain and Opioid Consumption in Women

Tourniquetless Total Knee Arthroplasty With Modern Perioperative Protocols Decreases Pain and Opioid Consumption in Women

Postoperative Pain Management in Total Knee Arthroplasty

The Impact of Preoperative Opioid Use Disorder on Complications and Costs following Primary Total Hip and Knee Arthroplasty

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