Preoperative opioid use is associated with worse patient outcomes after Total joint arthroplasty: a systematic review and meta-analysis

Abstract

Background A significant number of patients use opioids prior to total joint arthroplasty (TJA) in North America and there is growing concern that preoperative opioid use negatively impacts postoperative patient outcomes after surgery. This systematic review and meta-analysis evaluated the current evidence investigating the influence of preoperative opioid use on postoperative patient-reported outcomes (PRO) after total joint arthroplasty. Methods A systematic search was performed using Ovid, Embase, Cochrane Library, Scopus, Web of Science Core Collection, CINAHL on February 15th, 2018. Studies reporting baseline and postoperative PRO among those prescribed preoperative opioids and those who were not prior to total knee and hip arthroplasty were included. Standardized mean differences (SMD) in absolute difference and relative change in PRO measures between the two groups was calculated using random effect models. Results Six studies were included ( n = 7356 patients); overall 24% of patients were prescribed preoperative opioids. Patients with preoperative opioid use had worse absolute postoperative PRO scores when compared to those with no preoperative opioid use (standardized mean difference (SMD) -0.53, 95% Confidence interval (CI) -0.75, − 0.32, p < 0.0001). When relative change in PRO score was analyzed, as measured by difference between postoperative and preoperative PRO scores, there was no group differences (SMD -0.26, 95% CI -0.56, 0.05, p = 0.10). Conclusion Patients prescribed preoperative opioids may attain worse overall pain and function benefits after TJA when compared to opioid-naïve patients, but do still benefit from undergoing TJA. These results suggest preoperative opioid users should be judiciously counselled regarding potential postoperative pain and function improvements after TJA. Electronic supplementary material The online version of this article (10.1186/s12891-019-2619-8) contains supplementary material, which is available to authorized users.

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

“…ese differences persisted, even when controlling for demographic, procedural, and comorbid data. Alternatively, we do not suggest that prior OUD is a contraindication to arthroplasty as prior studies demonstrate these patients do improve [6]. However, these patients must be recognized and counseled that they are at high risk, and when possible, should be weaned from narcotics preoperatively to reduce their risk of complications [9,29].…”

“…is patient population must be counseled on their elevated risks. Furthermore, this study adds to the evidence suggesting these patients should be weaned from preoperative narcotics, as opioid freedom prior to surgery, even after longterm use, confers a risk reduction [6,7,9,27]. Future research may be directed at evaluating preoperative opioid use in morphine equivalents to determine cutoff values for safe surgery.…”

“…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].…”

The Surgeon's Role in the Opioid Crisis: A Narrative Review and Call to Action

“…Among orthopedic patient populations, who often have high rates of use prior to surgery (32), preoperative opioid abuse and dependence is associated with significant increases in morbidity and mortality after surgery (33). Among patients undergoing total joint replacement, preoperative opioid use is associated with less postoperative improvement in patient reported pain and function (34). Furthermore, recent studies have found that preoperative opioid users who undergo joint replacement are significantly more likely to suffer a periprosthetic joint infection (35) or require surgical revision (26,36).…”

Extensor Mechanism Ruptures and Reruptures: Perioperative Opioid Management

“…Orthopaedic surgeons are encountering increased readmission rates, reoperation rates, and decreased outcome scores and return to work rates among patients with heavy opioid use. [22][23][24][25] In our investigation, chronic preoperative opioid users demonstrated increased prevalence and risk for rerupture after quadriceps tendon repair when compared with acute and nonusers, albeit our small sample size limited our statistical power to find significance. Interestingly, following primary surgical repair of quadriceps prescription within 2 weeks of an injury were 2.4 times more likely to have a fall than any other mechanism of injury.…”