Prediction of Complications, Readmission, and Revision Surgery Based on Duration of Preoperative Opioid Use

Jain, Nikhil; Brock, J. Logan; Malik, Azeem Tariq; Phillips, Frank M.; Khan, Safdar N.

doi:10.2106/jbjs.18.00502

Cited by 100 publications

(106 citation statements)

References 38 publications

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“…Infectious complications have previously been associated with substance abuse, as Bauer et al found nearly a 40% infection rate in patients who illicitly use intravenous drugs after TKA [31]. Preoperative opioid use has been repeatedly associated with surgical site infections in arthroplasty [9,11,27] as well as other general surgery procedures [32,33]. Why this may be the case is likely multifactorial and could include patient and socioeconomic factors.…”

Section: Discussionmentioning

confidence: 99%

“…In the adult reconstruction realm, prior research has demonstrated that patients prescribed preoperative opioids are at higher risk for perioperative morbidity, revision, and less satisfactory outcomes [4][5][6][7][8][9][10][11]. Much attention has also been paid to postoperative opioid regimens, and there has been increasing recognition that conservative postoperative prescription patterns of opioids can be both safe and effective [12].…”

Section: Introductionmentioning

confidence: 99%

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

Wilson

Farley

Aizpuru

et al. 2019

Advances in Orthopedics

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Introduction. Multiple studies have demonstrated that patients taking opioids in the preoperative period are at elevated risk for complications following total hip (THA) and knee (TKA) arthroplasty. However, the incidence and impact of opioid use disorder (OUD) among these patients—both clinically and fiscally—remain unknown. The purpose of this study was to investigate this relationship. Methods. The Nationwide Readmission Database (NRD) was used to identify patients undergoing THA and TKA from 2011 to 2015. Coarsened exact matching was used to statistically match the OUD and non-OUD cohorts. Further analysis was then conducted on matched cohorts with multivariate analysis. The incidence of OUD was also determined, and the costs associated with this comorbidity were calculated. Results. The incidence of OUD in arthroplasty patients increased 80% over the study period. OUD patients had higher odds of prosthetic joint infection (OR 1.55, 95% CI 1.23–1.94), wound complication (OR 1.40, 95% CI 1.12–1.76), prosthetic complication (OR 1.37, 95% CI 1.10–1.70), and revision surgery (OR 1.47, 95% CI 1.19–1.81). OUD patients also had longer length of stays (TKA: +0.67 days; THA: +1.09 days), higher readmission (OR 1.60, 95% CI 1.43–1.79), and increased 90-day costs (TKA: +$3,602 [95% CI $3,138–4,065]; THA: +4,527 [95% CI $3,593–4,920). Conclusion. Opioid use disorder is becoming a more common comorbidity among THA and TKA patients. This is concerning as it represents a significant risk factor for postoperative complication. It additionally confers increased perioperative costs. Patients with OUD should be counseled on their elevated risk, and future work will be needed to determine if this is a modifiable risk factor.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Wilson

Farley

Aizpuru

et al. 2019

Advances in Orthopedics

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“…5,16 Recently, a study found increased rates of adverse events, such as wound complications, emergency department visits, and revision surgery, to be associated with preoperative opioid use. 8 However, opioid cessation may mitigate this risk, further emphasizing the need for greater understanding of factors associated with chronic opioid utilization. 8 Although several studies have examined opioid usage following foot and ankle procedures, there is a paucity of data on risk factors for prolonged opioid usage following TAA.…”

Section: Discussionmentioning

confidence: 99%

“…8 However, opioid cessation may mitigate this risk, further emphasizing the need for greater understanding of factors associated with chronic opioid utilization. 8 Although several studies have examined opioid usage following foot and ankle procedures, there is a paucity of data on risk factors for prolonged opioid usage following TAA. A recent prospective cohort study by Saini et al 17 identified 4 independent factors associated with increased opioid consumption following outpatient foot and ankle procedures: regional block anesthesia, age <60 years, preoperative visual analog scale score >6, hindfoot procedures, and bony procedures.…”

Section: Discussionmentioning

confidence: 99%

“…9,13,20 A recent study found preoperative opioid use to be associated with increased emergency room visits, wound complications, and revision surgery following total knee arthroplasty, total hip arthroplasty, and posterior spinal fusion. 8 As a result of the multitude of negative consequences of opioid use, prescribers have begun to consider alternative strategies for pain management in the perioperative setting and decrease the number of opioids they prescribe.…”

Section: Introductionmentioning

confidence: 99%

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Association of Preoperative Opioid Use and Prolonged Postoperative Opioid Use Following Total Ankle Arthroplasty

DeMik

Cychosz

Bedard

et al. 2020

Foot & Ankle Orthopaedics

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Background: Perioperative opioid consumption has received a great deal of recent attention. However, perioperative opioid utilization in the total ankle arthroplasty (TAA) population has not been well studied. We sought to identify factors associated with postoperative opioid use following TAA. Methods: The PearlDiver Research Program was used to query the Humana, Inc, administrative claims database from 2007 to 2017 for patients undergoing TAA. Additional variables of interest were identified using ICD-9 and ICD-10 codes. Preoperative opioid use was defined as having filled an opioid prescription in the 3 months before TAA. Prescription opioid claims data were tracked for 12 months postoperatively. Risk ratios (RRs) were calculated and multivariate analysis was performed at 3, 6, and 12 months postoperatively. Results: A total of 544 patients who underwent TAA were identified, with 180 (33.1%) filling an opioid prescription preoperatively. Those filling prescriptions preoperatively had a significantly greater risk for postoperative opioid use compared to those not taking opioids (RR: 4.36 [95% confidence interval (CI): 2.80-6.80] at 12 months). Anxiety or depression (RR: 2.27 [1.44-3.59]), low back pain (LBP) (RR: 2.27 [1.50-3.42]), and fibromyalgia (RR: 2.15 [1.42-3.28]) were also found to increase the risk of taking opioids at 12 months postoperatively. Multivariate analysis found preoperative opioid use to be the strongest predictor of postoperative opioid use. Conclusions: Nearly one-third of patients filled an opioid prescription within 3 months of TAA, and filling a prescription preoperatively was the strongest factor associated with postoperative opioid use. Fibromyalgia, depression or anxiety, and LBP were also associated with an increased likelihood of postoperative opioid use. Level of Evidence: Level III, retrospective cohort study.

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Opioids: Current Science

Talmage¹,

Snyder²

2021

AMA Guides® Newsletter

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Evidence shows that chronic opioid therapy is usually not beneficial; weaning patients off opioids many times results in less pain and better function, and opioid-induced hyperalgesia is real and frequent. Further evidence suggests that surgical outcomes are better if patients are weaned off opioids before surgery, and that the chronic use of opioids may adversely alter the assessment of maximum medical improvement (MMI).

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Prediction of Complications, Readmission, and Revision Surgery Based on Duration of Preoperative Opioid Use

Cited by 100 publications

References 38 publications

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

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

Association of Preoperative Opioid Use and Prolonged Postoperative Opioid Use Following Total Ankle Arthroplasty

Opioids: Current Science

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