Trends in Opioid Use during Hospitalization following Revision Total Hip Arthroplasty from 2016 to 2021

Abstract

Though opioids can be very effective for postoperative pain management after revision total hip arthroplasty (rTHA), many physicians have made an effort to decrease usage of these medications by focusing on alternative pain management strategies to reduce opioid dependence and unwanted side effects. This study sought to investigate trends in opioid consumption during hospitalization following rTHA from 2016 to 2021. We retrospectively reviewed all patients who received rTHA from January 2016 to April 2021. Baseline demographic variables including age, gender, race, body mass index, and American Society of Anesthesiologists classification were recorded. Additional information including patient-reported outcome measures (PROMs), postoperative outcomes, dosage, and type of opioid medication prescribed postoperatively were also collected. Opioid dosage and type were converted to milligram morphine equivalents (MMEs) per day of hospitalization and compared across the 6 years studied. Linear regression as well as t-tests were utilized to determine significant trends in MME consumption over time. In total, 1,096 patients met inclusion and exclusion criteria. The greatest daily average opioid consumption per patient was in 2017 (61.6 ± 155.4 MME per day) and the lowest was in 2021 (31.8 ± 105.8 MME per day). Linear regression analysis detected a downward trend of 4.97 MME per day each year, though these results were not statistically significant (R 2: 0.444, p = 0.089). t-Test analysis, however, did reveal a significant decrease in opioid consumption in the postprotocol cohort (38.41 ± 90.5 vs. 52.18 ± 120.2; p = 0.034). There was a significant increase in preoperative Hip Disability and Osteoarthritis Outcome Score, Joint Replacement scores (p = 0.007) over time as well as a significant decrease in preoperative visual analog scale pain scores (p = 0.012). The results of this study show that opioid consumption in 2021 was lower than in 2016 and 2017. This result emphasizes the effectiveness of protocols limiting opioid usage during hospitalization following rTHA. Moreover, the relatively consistent patient-reported outcome scores over time demonstrate that this decrease in opioid consumption per year does not impact patient-reported outcomes and satisfaction.