Influence of inpatient opioid consumption on persistent use following total knee arthroplasty

Abstract

BackgroundTotal knee arthroplasty (TKA) is associated with a high incidence of continued opioid use beyond the expected period of recovery. The aim of this study was to determine the influence of inpatient opioid consumption on the development of persistent use.MethodsOpioid-naïve patients undergoing primary, uncomplicated TKA were included in a prospective, observational study at a single institution. Postoperatively, opioids were prescribed by orthopedic advanced practitioners or resident physicians and administered by registered nurses. Individual inpatient prescriptions were adjusted, as needed, to facilitate optimal recovery conditions. Average hourly inpatient opioid consumption was calculated from total usage between midnight on the day of surgery until the time of hospital discharge. Persistent opioid use was defined as a prescription refill written by the orthopedic surgeon at the 6-week surgical follow-up visit. A multivariable regression model was used to identify independent risk factors associated with persistent use.ResultsA total of 351 patients were included in the analysis. Persistent opioid use was identified in 17.4% (61) of patients overall. A history of alcohol abuse (OR 7.80; 95% CI 2.13 to 28.55, p=0.002) was identified as an independent risk factor. Inpatient opioid consumption in the top quartile (equivalent to more than 10 mg of oxycodone every 4 hours) was not found to be associated with persistent use.ConclusionLarger amounts of opioid consumed in the hospital following uncomplicated, primary TKA may not be associated with an increased risk of persistent use at 6 weeks among opioid-naïve patients. Patients may have unique risk factors for prolonged opioid use that may not necessarily be apparent in the early postoperative period.

Factors associated with persistent opioid use 6–12 months after primary total knee arthroplasty

“…Lack of standardisation across prescribing patterns, definition of opioids and usage, and variability in recording periods makes direct comparisons between studies difficult. Rates of persistent opioid use range from 17% at 6 weeks [13] to 7.6% at 12 months [3] and up to 21% at 2 years postoperatively [14]. A recent systematic review from Europe covering eight countries demonstrated opioid use after 3–6 months between 7.9% and 41% after lower limb arthroplasty [15].…”

“…studies difficult. Rates of persistent opioid use range from 17% at 6 weeks[13] to 7.6% at 12 months[3] and up to 21%…”

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

“…32,35 Alcohol use is also associated with increased postoperative opioid use in TKA patients. 31,36 One study also demonstrated marijuana use as a significant risk factor for prolonged postoperative opioid use. 37…”

Buprenorphine management in the perioperative period: educational review and recommendations from a multisociety expert panel

“…12 13 However, recent evidence does not suggest a linkage in opioid-naïve patients undergoing total knee arthroplasty. 14 In those who have been diagnosed with OUD, treatment of pain with most full opioid agonists, such as oxycodone or morphine, puts already vulnerable patients at risk for recurrence or worsening of their active OUD. 12 13 US Food and Drug Administration (FDA)-approved medications for OUD include methadone, buprenorphine, and naltrexone, all of which have been found to be similar with respect to effectiveness, 15 16 with the caveat that the efficacy of naltrexone is comparable (in the short term) only if patients withdraw and abstain from opioid use for 7-10 days prior to initiation of therapy.…”