Risk for Prolonged Opioid Use Following Total Knee Arthroplasty in Veterans

Hadlandsmyth, Katherine; Weg, Mark W. Vander; McCoy, Kim; Mosher, Hilary J.; Vaughan-Sarrazin, Mary; Lund, Brian C.

doi:10.1016/j.arth.2017.08.022

Cited by 57 publications

(50 citation statements)

References 20 publications

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“…Log‐binomial regression was used to model risk for subsequent LTO with an array of independent variables including sociodemographic characteristics, medical diagnoses, and prescription medications that are potentially associated with long‐term use and commonly query‐able within electronic medical records . Diagnoses were identified by ICD‐9 and ICD‐10 codes from outpatient encounters during the year prior to opioid initiation.…”

Section: Methodsmentioning

confidence: 99%

Utility of accumulated opioid supply days and individual patient factors in predicting probability of transitioning to long‐term opioid use: An observational study in the Veterans Health Administration

Hadlandsmyth

Mosher

Weg

et al. 2020

Pharmacology Res & Perspec

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Initial supply days dispensed to new users is strongly predictive of future long-term opioid use (LTO). The objective was to examine whether a model integrating additional clinical variables conferred meaningful improvement in predicting LTO, beyond a simple approach using only accumulated supply. Three cohorts were created using Veteran's Health Administration data based on accumulated supply days during the 90 days following opioid initiation: (a) <30 days, (b) ≥30 days, (c) ≥60 days. A base, unadjusted probability of subsequent LTO (days 91-365) was calculated for each cohort, along with an associated risk range based on midpoint values between cohorts. Within each cohort, log-binomial regression modeled the probability of subsequent LTO, using demographic, diagnostic, and medication characteristics. Each patient's LTO probability was determined using their individual characteristic values and model parameter estimates, where values falling outside the cohort's risk range were considered a clinically meaningful change in predictive value. Base probabilities for subsequent LTO and associated risk ranges by cohort were as follows: (a) 3.92% (0%-10.75%), (b) 17.59% (10.76%-28.05%), (c) 38.53% (28.06%-47.55%). The proportion of patients whose individual probability fell outside their cohort's risk range was as follows: 1.5%, 4.6%, and 9.2% for cohorts 1, 2, and 3, respectively. The strong relationship between accumulated supply days and future LTO offers an opportunity to leverage electronic healthcare records for decision support in preventing the initiation of inappropriate LTO through early intervention. More complex models are unlikely to meaningfully guide decision making beyond the single variable of accumulated supply days.

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Section: Methodsmentioning

confidence: 99%

Utility of accumulated opioid supply days and individual patient factors in predicting probability of transitioning to long‐term opioid use: An observational study in the Veterans Health Administration

Hadlandsmyth

Mosher

Weg

et al. 2020

Pharmacology Res & Perspec

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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

192

150

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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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“…Within our multivariable model, the strongest and most consistent predictor of AOP was opiate use within 30 days prior to surgery. Presence of preoperative pain has been identified as a significant risk factor for both prolonged pain and increased analgesic requirements in orthopaedics, [26][27][28] general surgery, 29 as well as otolaryngology. 15 We found that patients with preoperative opioid use were significantly more likely (OR: 104.45, 95% CI: 1.41-7,751.10) than opioid-naïve patients to require AOP.…”

Section: Discussionmentioning

confidence: 99%

Incidence and Predictive Factors for Additional Opioid Prescription after Endoscopic Skull Base Surgery

Shen

Jafari

Qualliotine

et al. 2019

J Neurol Surg B Skull Base

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Introduction Postoperative pain management and opioid use following endoscopic skull base surgery (ESBS) is not well understood. A subset of patients requires additional opioid prescription (AOP) in the postoperative period. The objective of this study is to describe the incidence of AOP, as well as evaluate patient and surgical characteristics that may predict additional pain management requirements following ESBS. Methods A retrospective review of cases undergoing ESBS between November 2016 and August 2018 was performed. We reviewed patients' sociodemographic and clinical data, and Controlled Substance Utilization Review and Evaluation System (CURES) records. Stepwise multivariable logistic regressions were performed to evaluate the factors associated with AOP within 60 days following surgery. Results A total of 42 patients were identified. Indications for ESBS included intracranial mass (64.2%), sinonasal malignancy (23.8%), and skull base reconstruction (9.5%). AOP were recorded in nine patients (21.4%). There were no significant differences in operative factors, including approach, lesion location, or perioperative analgesia between the two cohorts. On multivariable logistic regression, we found that younger age (odds ratio [OR]: 0.891, 95% confidence interval [CI]: 0.79–1.00, p = 0.050), comorbid depression (OR: 86.48, 95% CI: 1.40–5,379.07, p = 0.034), and preoperative opioid use (OR: 104.45, 95% CI: 1.41–7,751.10, p = 0.034) were associated with additional prescriptions postoperatively. Conclusion The requirement for extended postoperative opioid pain control is common after ESBS. Patient demographics including age and psychosocial factors, such as depression may predict the need for AOP after ESBS. These results suggest that patient-driven factors, rather than surgical characteristics, may determine the need for prolonged pain control requirements after ESBS.

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Risk for Prolonged Opioid Use Following Total Knee Arthroplasty in Veterans

Cited by 57 publications

References 20 publications

Utility of accumulated opioid supply days and individual patient factors in predicting probability of transitioning to long‐term opioid use: An observational study in the Veterans Health Administration

Utility of accumulated opioid supply days and individual patient factors in predicting probability of transitioning to long‐term opioid use: An observational study in the Veterans Health Administration

Postoperative Pain Management in Total Knee Arthroplasty

Incidence and Predictive Factors for Additional Opioid Prescription after Endoscopic Skull Base Surgery

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