Preoperative Opioid Use Increases the Cost of Care in Total Joint Arthroplasty

Abstract

Introduction: Predictors of financial costs related to total joint arthroplasty (TJA) have become increasingly important becuase payment methods have shifted from fee for service to bundled payments. The purpose of this study was to assess the relationship between preoperative opioid use and cost of care in primary TJA. Methods: A retrospective study was conducted in Medicare patients who underwent elective unilateral primary total knee or hip arthroplasty between 2015 and 2018. Preoperative opioid usage, comorbidities, length of stay, and demographic information were obtained from chart review. The total episode-of-care (EOC) cost data was obtained from the Centers of Medicare and Medicaid Services based on Bundled Payments for Care Improvement Initiative Model 2, including index hospital and 90-day postacute care costs. Patients were grouped based on preoperative opioid usage. Costs were compared between groups, and multivariate linear regression analyses were performed to analyze whether preoperative opioid usage influenced the cost of TJA care. Analyses were risk-adjusted for patient risk factors, including comorbidities and demographics. Results: A total of 3,211 patients were included in the study. Of the 3,211 TJAs, 569 of 3,211 patients (17.7%) used preoperative opioids, of which 242 (42.5%) only used tramadol. EOC costs were significantly higher for opioid and tramadol users than nonopioid users ($19,229 versus $19,403 versus $17,572, P < 0.001). Multivariate regression predicted that the use of preoperative opioids in TJA was associated with increased EOC costs by $789 for opioid users (95% confidence interval [CI] $559 to $1,019, P < 0.001) and $430 for tramadol users (95% CI $167 to $694, P = 0.001). Total postacute care costs were also increased by 70% for opioid users (95% CI 44% to 102%, P < 0.001) and 48% for tramadol users (95% CI 22% to 80%, P < 0.001). Discussion: This study demonstrated that preoperative opioid usage was associated with higher cost of care in TJA. Limiting preoperative opioid use for pain management before TJA could contribute to cost savings within a bundled model.

Factors Associated With Increasing Length of Stay for Rheumatoid Arthritis Patients Undergoing Total Hip Arthroplasty and Total Knee Arthroplasty

“…Additionally, in chronic opioid users the median in medical costs was $1,084 and patients had a 64% lower rate of opioid cessation. Bell et al [ 1 ] reported that preoperative opioid use was associated with increased total episode of care costs compared to non-users ($19,229 vs $17,552) with increased cost of care of $789.00 and postacute care costs were increased 70%. This has not previously been assessed in patients with RA.…”

Total Joint Arthroplasty Training (Prehabilitation and Rehabilitation) in Lower Extremity Arthroplasty

“…References 14,15,[25][26][27]32,35,41, and 47 are level II studies. References 3,5,6,7,8,9,10,24,28,40,45, and 46 are level III studies. Reference 1 is a systematic review of level IV evidence study.…”

“…3 Standardization of perioperative TJA clinical processes, including risk factor modification, comprehensive pain alleviation strategies, tranexamic acid, and venous thromboembolism prophylaxis, has improved postoperative clinical outcomes and reduced the TJA episode of care costs. 4-10 However, perioperative TJA training (prehabilitation: training provided preoperatively and rehabilitation: training provided postoperatively) has failed to reach the level of standardization realized with the aforementioned aspects of TJA care.…”

The Ramifications of Opioid Utilization and Outcomes of Alternative Pain Control Strategies for Total Knee Arthroplasties

“…In a study of 3,211 TJA patients who either used opioids, tramadol, or were opioid-naive preoperatively, cost of care was $19,229 versus $19,403 versus $17,572, respectively (P < 0.001). 17 Overall, while opioid use preoperatively and postoperatively is often indicated for adequate pain control, they should be utilized carefully in light of emerging evidence about their multifaceted effects.…”