Associations between pre-surgical daily opioid use and short-term outcomes following knee or hip arthroplasty: a prospective, exploratory cohort study

Abstract

Background: Retrospective studies have found that daily opioid use pre-arthroplasty predicts worse longer-term service, clinical and patient-reported outcomes. Prospective studies are needed to confirm these observations. This prospective, exploratory study aimed to determine: the proportion of total knee or hip arthroplasty (TKA, THA) patients who use opioids regularly (daily) pre-surgery; if opioid use pre-surgery is associated with acute and subacute outcomes to 12-weeks post-surgery. Methods: Consecutive patients undergoing primary TKA or THA were prospectively enrolled pre-surgery and followed-up by telephone to 12-weeks post-surgery. Acute-care (oral morphine equivalent dosage (OMED), length of stay, discharge to inpatient rehabilitation, complications) and 12-week outcomes (Oxford Knee or Hip Score, Euroqol 'today' health score, current use of opioids, and complications including readmissions) were monitored. Unadjusted and adjusted Odds Ratios (ORs) (95% Confidence Interval, CI), Rate Ratios and β coefficients (standard error) were calculated. Results: Five Hundred Twenty-One patients were included (TKA n = 381). 15.7% (95%CI 12.6 to 18.9) used opioids regularly pre-surgery. 86.8% (452/521) were available for follow-up at 12-weeks. In unadjusted analyses, pre-surgical opioid use was significantly associated with higher average acute daily OMED [β 0.40 (0.07), p < 0.001], presence of an acute complication [OR 1.75 (1.02 to 3.00)], and ongoing use of opioids at 12-weeks [OR 5.06 (2.86 to 8.93)]. After adjusting for covariates, opioid use pre-surgery remained significantly associated with average acute daily OMED [β 0.40 (0.07), p < 0.001] and ongoing use at 12-weeks [OR 5.38 (2.89 to 9.99)]. Conclusion: People who take daily opioids pre-surgery have significantly greater odds for greater opioid consumption acutely and ongoing use post-surgery. Adequately powered prospective studies are required to confirm whether pre-surgical opioid use is or is not associated with poorer joint and quality of life scores or a complication in the short-term.

Opioid use and patient outcomes in an Australian hip and knee arthroplasty cohort

“…22 As opioids are prescribed by internal medicine or primary care providers in 60%-70% of arthroplasty cases, 31 careful coordination and communication between orthopaedic surgeons, patients and other primary care providers as to expectations for opioid use may be paramount to successfully managing prolonged opioid use in this population. 21,31 Opioid use before and after arthroplasty observed in this study were considerably lower than many previous studies, but considerable geographical variation is commonly reported. 19 In the largest series of a US cohort from 2010 to 2014 Jin 19 examined 473 781 subjects and found 31% of TKR and 41% of THR subjects reported opioid use in the month before arthroplasty.…”

“…15,16 These rates are more than double the rate of our cohort, and similar to US based studies, but may be influenced by the exclusively veteran sample. Naylor 21 examined 521 THA or TKA subjects in an Australian public hospital cohort of whom 16% reported regular opioid use before, and 30% at 3 months after arthroplasty. In our cohort opioid use within the previous week was reported by 18% before surgery, 28% at 6 weeks and only 7% at 6 months.…”

“…To minimize prolonged opioid use most effectively clinicians need to address it before arthroplasty, weaning to the lowest possible dose 22 . As opioids are prescribed by internal medicine or primary care providers in 60%–70% of arthroplasty cases, 31 careful coordination and communication between orthopaedic surgeons, patients and other primary care providers as to expectations for opioid use may be paramount to successfully managing prolonged opioid use in this population 21,31 …”

“…7,8,11,[13][14][15][16][17][18][19][20] Most of these epidemiological studies arise from populations in the US, where there are much higher rates of opioid use, compared to Australasia and Europe. The rate of opioid use in Australia has been reported in exclusively veteran and uninsured cohorts, and varies from 16% to 46% preoperatively, and 30%-36% >3 months after arthroplasty, 15,16,21 with elevated rates observed in veterans. The aim of this study was to determine the prevalence of opioid use before and after THA and TKA in a privately insured Australian population and examine its association with patient factors and patient reported outcomes.…”

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

“…The connection between preoperative opioid use and chronic postoperative opioid use is well established in orthopaedic literature. 10,[18][19][20][21][22][23][24] This preoperative use is often…”