Narcotic use and total hip arthroplasty

Bolarinwa, Surajudeen A.; Casp, Aaron; Cancienne, Jourdan M.; Werner, Brian C.; Browne, James A.

doi:10.1177/1120700018781759

Cited by 16 publications

(14 citation statements)

References 14 publications

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“…Earlier, we found that analgesic drug consumption is reduced after hip and knee arthroplasty at the population level [36], and that obesity, a higher number of comorbidities, gender (women more than men), and preoperative use of analgesics were associated with the postoperative use of opioids, NSAIDs, or acetaminophen [38]. Previous studies have almost exclusively focused on opioid consumption, although psychiatric disorders, worse preoperative pain, and catastrophizing have also been associated with increased consumption of opioids after joint arthroplasty [4, 12, 22, 24, 25, 27, 32, 42, 43]. These factors have also been correlated with persistent pain [10, 28–30, 37, 45].…”

Section: Introductionmentioning

confidence: 99%

Is the Preoperative Use of Antidepressants and Benzodiazepines Associated with Opioid and Other Analgesic Use After Hip and Knee Arthroplasty?

Rajamäki

Moilanen

Puolakka

et al. 2021

Clin Orthop Relat Res

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Background Mental health disorders can occur in patients with pain conditions, and there have been reports of an increased risk of persistent pain after THA and TKA among patients who have psychological distress. Persistent pain may result in the prolonged consumption of opioids and other analgesics, which may expose patients to adverse drug events and narcotic habituation or addiction. However, the degree to which preoperative use of antidepressants or benzodiazepines is associated with prolonged analgesic use after surgery is not well quantified. Question/purposes (1) Is the preoperative use of antidepressants or benzodiazepine medications associated with a greater postoperative use of opioids, NSAIDs, or acetaminophen? (2) Is the proportion of patients still using opioid analgesics 1 year after arthroplasty higher among patients who were taking antidepressants or benzodiazepine medications before surgery, after controlling for relevant confounding variables? (3) Does analgesic drug use decrease after surgery in patients with a history of antidepressant or benzodiazepine use? (4) Does the proportion of patients using antidepressants or benzodiazepines change after joint arthroplasty compared with before? Methods Of the 10,138 patients who underwent hip arthroplasty and the 9930 patients who underwent knee arthroplasty at Coxa Hospital for Joint Replacement, Tampere, Finland, between 2002 and 2013, those who had primary joint arthroplasty for primary osteoarthritis (64% [6502 of 10,138] of patients with hip surgery and 82% [8099 of 9930] who had knee surgery) were considered potentially eligible. After exclusion of another 8% (845 of 10,138) and 13% (1308 of 9930) of patients because they had revision or another joint arthroplasty within 2 years of the index surgery, 56% (5657 of 10,138) of patients with hip arthroplasty and 68% (6791 of 9930) of patients with knee arthroplasty were included in this retrospective registry study. Patients who filled prescriptions for antidepressants or benzodiazepines were identified from a nationwide drug prescription register, and information on the filled prescriptions for opioids (mild and strong), NSAIDs, and acetaminophen were extracted from the same database. For the analyses, subgroups were created according to the status of benzodiazepine and antidepressant use during the 6 months before surgery. First, the proportions of patients who used opioids and any analgesics (that is, opioids, NSAIDs, or acetaminophen) were calculated. Then, multivariable logistic regression adjusted with age, gender, joint, Charlson Comorbidity Index, BMI, laterality (unilateral/same-day bilateral), and preoperative analgesic use was performed to calculate odds ratios for any analgesic use and opioid use 1 year postoperatively. Additionally, the proportion of patients who used antidepressants and benzodiazepines was calculated for 2 years before and 2 years after surgery. Results At 1 year postoperatively, patients with a history of antidepressant or benzodiazepine use were more likely to fill prescriptions for any analgesics than were patients without a history of antidepressant or benzodiazepine use (adjusted odds ratios 1.9 [95% confidence interval 1.6 to 2.2]; p < 0.001 and 1.8 [95% CI 1.6 to 2.0]; p < 0.001, respectively). Similarly, patients with a history of antidepressant or benzodiazepine use were more likely to fill prescriptions for opioids than patients without a history of antidepressant or benzodiazepine use (adjusted ORs 2.1 [95% CI 1.7 to 2.7]; p < 0.001 and 2.0 [95% CI 1.6 to 2.4]; p < 0.001, respectively). Nevertheless, the proportion of patients who filled any analgesic prescription was smaller 1 year after surgery than preoperatively in patients with a history of antidepressant (42% [439 of 1038] versus 55% [568 of 1038]; p < 0.001) and/or benzodiazepine use (40% [801 of 2008] versus 55% [1098 of 2008]; p < 0.001). The proportion of patients who used antidepressants and/or benzodiazepines was essentially stable during the observation period. Conclusion Surgeons should be aware of the increased risk of prolonged opioid and other analgesic use after surgery among patients who were on preoperative antidepressant and/or benzodiazepine therapy, and they should have candid discussions with patients referred for elective joint arthroplasty about this possibility. Further studies are needed to identify the most effective methods to reduce prolonged postoperative opioid use among these patients. Level of Evidence Level III, therapeutic study.

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Section: Introductionmentioning

confidence: 99%

Is the Preoperative Use of Antidepressants and Benzodiazepines Associated with Opioid and Other Analgesic Use After Hip and Knee Arthroplasty?

Rajamäki

Moilanen

Puolakka

et al. 2021

Clin Orthop Relat Res

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“…Persistent pain may also lead to the increased consumption of analgesics [8]. To date, however, only a limited number of large-scale studies have been conducted on the trajectories of analgesic consumption and the risk factors associated with increased analgesic consumption after surgery [9][10][11][12][13][14][15][16][17][18][19][20][21], even though the risks for adverse events of opioids and non-steroidal anti-inflammatory drugs increase in long-term use [22][23][24], especially in elderly patients with comorbidities. Motivated by the ongoing opioid prescription crisis [25], most recent studies have focused on opioid use after joint replacement and reported higher odds for prolonged postoperative opioid use in association with psychiatric disorders, preoperative opioid use, worse preoperative pain, younger age, cardiac disease, and undergoing knee (compared to hip) surgery [9][10][11][12][13][14][15][16][17]26].…”

Section: Introductionmentioning

confidence: 99%

Predictors of the use of analgesic drugs 1 year after joint replacement: a single-center analysis of 13,000 hip and knee replacements

et al. 2020

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Background: Pain persists in a moderate number of patients following hip or knee replacement surgery. Persistent pain may subsequently lead to the prolonged consumption of analgesics after surgery and expose patients to the adverse drug events of opioids and NSAIDs, especially in older patients and patients with comorbidities. This study aimed to identify risk factors for the increased use of opioids and other analgesics 1 year after surgery and focused on comorbidities and surgery-related factors. Methods: All patients who underwent a primary hip or knee replacement for osteoarthritis from 2002 to 2013 were identified. Redeemed prescriptions for acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs), and opioids (mild and strong) were collected from a nationwide Drug Prescription Register. The user rates of analgesics and the adjusted risks ratios for analgesic use 1 year after joint replacement were calculated.Results: Of the 6238 hip replacement and 7501 knee replacement recipients, 3591 (26.1%) were still using analgesics 1 year after surgery. Significant predictors of overall analgesic use (acetaminophen, NSAID, or opioid) were (risk ratio (95% CI)) age 65-74.9 years (reference < 65), 1.1 (1.03-1.2); age > 75 years, 1.2 (1.1-1.3); female gender, 1.2 (1.1-1.3); BMI 30-34.9 kg/m 2 (reference < 25 kg/m 2 ), 1.1 (1.04-1.2); BMI > 35 kg/m 2 , 1.4 (1.3-1.6); and a higher number of comorbidities (according to the modified Charlson Comorbidity Index score), 1. 2 (1.1-1.4). Diabetes and other comorbidities were not significant independent predictors. Of the other clinical factors, the preoperative use of analgesics, 2.6 (2.5-2.8), and knee surgery, 1.2 (1.1-1.3), predicted the use of analgesics, whereas simultaneous bilateral knee replacement (compared to unilateral procedure) was a protective factor, 0.86 (0.77-0.96). Opioid use was associated with obesity, higher CCI score, epilepsy, knee vs hip surgery, unilateral vs bilateral knee operation, total vs unicompartmental knee replacement, and the preoperative use of analgesics/opioids. Conclusions: Obesity (especially BMI > 35 kg/m 2 ) and the preoperative use of analgesics were the strongest predictors of an increased postoperative use of analgesics. It is remarkable that also older age and higher number of comorbidities predicted analgesic use despite these patients being the most vulnerable to adverse drug events.

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“…Persistent pain may also lead to the increased consumption of analgesics (8). To date, however, only a limited number of large-scale studies have been conducted on the trajectories of analgesic consumption and the risk factors associated with increased analgesic consumption after surgery (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21), even though the risks for adverse events of opioids and non-steroidal anti-inflammatory drugs increase in long-term use (22)(23)(24), especially in elderly patients with comorbidities. Motivated by the ongoing opioid prescription crisis (25), most recent studies have focused on opioid use after joint replacement and reported higher odds for prolonged postoperative opioid use in association with psychiatric disorders, preoperative opioid use, worse preoperative pain, younger age, cardiac disease, and undergoing knee (compared to hip) surgery (9,10,(14)(15)(16)(17)(18)(19)(20)26).…”

Section: Introductionmentioning

confidence: 99%

Predictors of the use of analgesic drugs 1 year after joint replacement: a single-center analysis of 13,000 hip and knee replacements

Rajamäki

Moilanen

Puolakka³

et al. 2020

Preprint

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Background Pain persists in a moderate number of patients following hip or knee replacement surgery. Persistent pain may subsequently lead to the prolonged consumption of analgesics after surgery and expose patients to the adverse drug events of opioids and NSAIDs, especially in older patients and patients with comorbidities. This study aimed to identify risk factors for the increased use of opioids and other analgesics one year after surgery and focused on comorbidities and surgery-related factors. Methods All patients who underwent a primary hip or knee replacement for osteoarthritis from 2002 to 2013 were identified. Redeemed prescriptions for acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs), and opioids (mild and strong) were collected from a nationwide Drug Prescription Register. The user rates of analgesics and the adjusted risks ratios for analgesic use one year after joint replacement were calculated. Results Of the 6,238 hip replacement and 7,501 knee replacement recipients, 3,591 (26.1%) were still using analgesics one year after surgery. Significant predictors of overall analgesic use (acetaminophen, NSAID, or opioid) were (risk ratio (95% CI)) age 65-74.9 years (reference <65), 1.1 (1.03-1.2), age > 75 years, 1.2 (1.1-1.3), female gender, 1.2 (1.1-1.3), BMI 30-34.9 kg/m2 (reference <25kg/m2), 1.1 (1.04-1.2), BMI >35 kg/m2, 1.4 (1.3-1.6), a higher number of comorbidities (according to modified Charlson Comorbidity Index score), and 1.2 (1.1-1.4). Diabetes and other comorbidities were not significant independent predictors. Of the other clinical factors, the preoperative use of analgesics, 2.6 (2.5-2.8) and knee surgery, 1.2 (1.1-1.3), predicted the use of analgesics, whereas simultaneous bilateral knee replacement (compared to unilateral procedure) was a protective factor, 0.86 (0.77-0.96). Opioid use was associated with obesity, higher CCI score, epilepsy, knee vs hip surgery, unilateral vs bilateral knee operation, total vs unicompartmental knee replacement, and the preoperative use of analgesics/opioids. Conclusions Obesity (especially BMI >35 kg/m2) and the preoperative use of analgesics were the strongest predictors of an increased postoperative use of analgesics. It is remarkable that also older age and higher number of comorbidities predicted analgesic use despite these patients being the most vulnerable to adverse drug events.

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Narcotic use and total hip arthroplasty

Abstract: Preoperative narcotic use is the most significant patient specific risk factor for prolonged postoperative narcotic use. POUs and PPUs are at a significantly higher risk of postoperative infection and revision surgery.

Cited by 16 publications

References 14 publications

Is the Preoperative Use of Antidepressants and Benzodiazepines Associated with Opioid and Other Analgesic Use After Hip and Knee Arthroplasty?

Is the Preoperative Use of Antidepressants and Benzodiazepines Associated with Opioid and Other Analgesic Use After Hip and Knee Arthroplasty?

Predictors of the use of analgesic drugs 1 year after joint replacement: a single-center analysis of 13,000 hip and knee replacements

Predictors of the use of analgesic drugs 1 year after joint replacement: a single-center analysis of 13,000 hip and knee replacements

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