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

Wilson, Jacob M.; Farley, Kevin X.; Aizpuru, Matthew; Wagner, Eric R.; Bradbury, Thomas L.; Guild, George N.

doi:10.1155/2019/9319480

Cited by 36 publications

(30 citation statements)

References 38 publications

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“…The survey we used attempted to quantify patient-reported disease severity, perceptions related to surgical delays, and the implications that this may have with regard to their willingness and eagerness to reengage the healthcare system. Some of our questions were derived from prior, similar studies [34, 35], while others were aimed at addressing potential provider concerns [30, 39]. While some patients reported multiple pain generators, we explicitly asked that they attempt to isolate perceptions of their pre-surgical joint.…”

Section: Methodsmentioning

confidence: 99%

Patient Perceptions of COVID-19-Related Surgical Delay: An Analysis of Patients Awaiting Total Hip and Knee Arthroplasty

et al. 2020

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Background: COVID-19 has caused unprecedented delays in elective orthopedic surgery. Understanding patients' perceptions of the disruptions in care and their willingness to reengage the healthcare system are crucial to planning the resumption of elective care. Questions/ Purposes: The purpose of this study was to elicit patient perceptions about delays in total joint arthroplasty during the COVID-19 pandemic. Methods: We identified a consecutive series of patients who experienced COVID-19-driven delays to scheduled total hip or knee arthroplasty at an urban, academic medical center in the Southeastern United States. A 20-item survey was administered via telephone. Answers were recorded and descriptive statistics were performed. A post hoc χ-square analysis compared characteristics and outlooks of patients who did and did not immediately desire surgery. Results: Of 111 patients (64% of those identified) who met inclusion criteria and completed the survey, 96% said they felt that they were treated fairly and 90% said that the surgical delay was in their best interest; 68% reported emotional distress from the delay, but 45% reported a desire to wait longer for the pandemic to subside. Lower jointfunction scores, higher pain levels, higher pain catastrophizing scores, and longer latency from personally deciding to pursue surgery were associated with the reported need for immediate surgery. Conclusion: Overall, patients reported that they understood the need for elective surgical delays during the COVID-19 pandemic. However, the psychological implications they reported were not negligible. Patient preference for immediate reengagement with the healthcare system was dichotomous, with many patients favoring precautionarily furthering the delay. Understanding these preferences will help optimize elective orthopedic care during unprecedented times.

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Section: Methodsmentioning

confidence: 99%

Patient Perceptions of COVID-19-Related Surgical Delay: An Analysis of Patients Awaiting Total Hip and Knee Arthroplasty

et al. 2020

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“…Quality of life (Short-Form 36) was found to be approximately two standard deviations below normal population scores. It is also well known that patients waiting for hip or knee arthroplasty are often prescribed opioids, leading to increased postoperative opioid tolerance, potential opioid addiction, increased perioperative complication rates and overall costs [12][13][14].…”

Section: Discussionmentioning

confidence: 99%

It is not ‘business as usual’ for orthopaedic surgeons in May 2020– the Austrian-German-Swiss experience

et al. 2020

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Purpose: To document the status-quo of orthopaedic health-care services as the COVID-19 pandemic recedes, and to determine the rate of resumption of orthopaedic surgery in the German-speaking countries in May 2020. Methods: A prospective online survey was sent out to 4234 surgeons of the AGA-Society of Arthroscopy and Joint-Surgery (Gesellschaft für Arthroskopie und Gelenkchirurgie, AGA). The survey was created using SurveyMonkey software and consisted of 23 questions relating to the reduction of orthopaedic services at the participating centres and the impact that the pandemic is having on each surgeon. Results: A total of 890 orthopaedic surgeons responded to the online survey. Approximately 90% of them experienced a reduction in their surgical caseload and patient contact. 38.7% stated that their institutions returned to providing diagnostic arthroscopies. 54.5% reported that they went back to performing anterior cruciate ligament reconstructions (ACLR), 62.6% were performing arthroscopic meniscus procedures, and 55.8% had resumed performing shoulder arthroscopy. Only 31.9% of the surgeons were able to perform elective total joint arthroplasty. 60% of the participants stated that they had suffered substantial financial loss due to the pandemic. Conclusion: A gradual resumption of orthopaedic health-care services was observed in May 2020. Typical orthopaedic surgical procedures like ACLR, shoulder arthroscopy and elective total joint arthroplasty were reported to be currently performed by 54%, 56% and 32% of surgeons, respectively. Despite signs of improvement, it appears that there is a prolonged curtailment of orthopaedic health-care at present in the middle of Europe.

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“…8,9,40,41,44 Concerning total joint arthroplasty, numerous publications have cited preoperative and perioperative opioid use as risk factors for deleterious outcomes after surgery, noting increased health care utilization and increased rates of prosthetic joint infection and revision surgery. 4,6,7,20,56,59 Similar studies have also identified preoperative opioid use as a negative predictor of patient-reported outcome measure scores, with lower preoperative baseline scores and lower overall change in function after arthroplasty. 12,31,32,33,50 A similar relationship has been found in patients undergoing RCR.…”

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confidence: 78%

“…In light of the opioid epidemic, 54 discerning the effect of opioid use on patient outcomes is paramount. While previous studies have addressed the effect of preoperative opioid use on the development of postoperative complications in numerous general and orthopaedic surgical procedures, 3,6,7,56,59 researchers know little about this relationship in patients undergoing RCR. Specific to RCR, existing literature has focused on the effect of preoperative opioids on patient-reported outcomes, finding less robust improvements in patient-reported outcome measure scores in opioid use groups.…”

Section: Discussionmentioning

confidence: 99%

Preoperative Opioid Use Is a Risk Factor for Revision Surgery, Complications, and Increased Resource Utilization After Arthroscopic Rotator Cuff Repair

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Background: Studies have shown preoperative opioid use to influence outcomes after various surgical procedures. Researchers have not assessed this relationship after rotator cuff repair (RCR). Hypothesis/Purpose: The purpose of this study was to assess the relationship between preoperative opioid use and outcomes after arthroscopic RCR. We hypothesized that patients prescribed higher daily averages of preoperative oral morphine equivalents (OMEs) would show increased rates of 90-day complications and 3-year revision surgery. Study Design: Cohort study; Level of evidence, 3. Methods: The MarketScan claims database was utilized to identify patients who underwent arthroscopic RCR between 2009 and 2018. We used preoperative opioid use status to divide patients into groups based on the average daily OMEs consumed in the 6 months before surgery: opioid-naïve, <1, 1-<5, 5-<10, and ≥10 OMEs per day. We retrieved 90-day complication and 3-year revision surgery rates. Opioid use groups were then compared with binomial logistic regression and generalized linear models. Results: We identified 214,283 patients. Of those patients, 50.7% did not receive any preoperative opioids, while 7.7%, 26.8%, 6.3%, and 8.6% received <1, 1-<5, 5-<10, and ≥10 OMEs per day over a 6-month time period, respectively. Complications increased with increasing preoperative OMEs. Multivariate analysis revealed that any patient using ≥1 OME per day had increased rates of 3-year revision surgery, reoperations, and infections. Specifically, patients averaging ≥10 OMEs per day showed a 103% (odds ratio, 2.03 [95% CI, 1.62-2.54]; P < .001) increase in the odds of revision surgery compared with opioid-naïve patients. Rates of hospital admissions and postoperative emergency department encounters were higher in all opioid use groups. Adjusted differences in 6-month preoperative and 3-month postoperative health care costs were seen in the opioid use groups compared with opioid-naïve patients, ranging from US$1307 to US$5820 ( P < .001). Conclusion: Preoperative opioid use was a risk factor for complications and revision surgery after arthroscopic RCR. We also observed a dose-dependent response between opioid use and postoperative complications.

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

Cited by 36 publications

References 38 publications

Patient Perceptions of COVID-19-Related Surgical Delay: An Analysis of Patients Awaiting Total Hip and Knee Arthroplasty

Patient Perceptions of COVID-19-Related Surgical Delay: An Analysis of Patients Awaiting Total Hip and Knee Arthroplasty

It is not ‘business as usual’ for orthopaedic surgeons in May 2020– the Austrian-German-Swiss experience

Preoperative Opioid Use Is a Risk Factor for Revision Surgery, Complications, and Increased Resource Utilization After Arthroscopic Rotator Cuff Repair

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