Prolonged opioid use before knee or hip replacement surgery increases risk of poor outcomes

July 18, 2018, Wolters Kluwer Health

Patients who take prescription opioids for more than 60 days before total knee or hip replacement surgery are at significantly higher risk of being readmitted to the hospital and of undergoing repeat joint-replacement surgery, compared to patients with no preoperative opioid use, reports a study in the July 18 issue of The Journal of Bone & Joint Surgery.

"Opioid use should be considered yet another risk factor for surgeons and patients to consider prior to elective primary joint arthroplasty," write Hue H. Luu, MD, and colleagues of The University of Chicago. They note that more than half of patients in their national database study had at least one opioid prescription filled before undergoing total knee or hip arthroplasty (TKA or THA).

Opioid Use Linked to Increased Rehospitalization and Reoperation Risks after TKA or THA

The study included approximately 324,000 patients who underwent TKA (233,000 patients) or THA (91,000) between 2003 and 2014. All patients had at least one year of follow-up data, while about 160,000 patients had three years of follow-up.

Patients were identified from a national database that included both private insurance and Medicare data. Preoperative opioid use was assessed as a risk factor for two major adverse outcomes: readmission to the hospital within 30 days and repeat joint-replacement surgery (revision arthroplasty) within one to three years.

In the one-year follow-up group, about 51 percent of TKA patients and 56 percent of THA patients had one or more opioid prescriptions filled in the six months before the procedure. Rates of prolonged preoperative opioid use—more than 60 days—were 16 percent for TKA patients and 19 percent for THA patients.

Prolonged opioid use was associated with an increased risk of both adverse outcomes. For TKA patients, the hospital readmission rate was 4.82 percent among those with no preoperative opioid use versus 6.17 percent for those with more than 60 days of opioid use. For THA patients, the rates were 3.71 versus 5.85 percent, respectively.

At one-year follow-up, the rate of revision TKA was 1.07 percent for patients with no preoperative opioids versus 2.14 percent for those with prolonged opioid use. For THA, the revision rates were 0.38 versus 1.10 percent, respectively.

The increased risks associated with prolonged preoperative opioid use were also significant in the three-year follow-up group. In both groups the opioid-related increases in risk remained significant after adjustment for age, sex, and a "comorbidity index" reflecting other medical conditions. The authors note some limitations of their study, including a lack of data on the cause of repeat surgery or the reason for readmission.

Amid the ongoing opioid epidemic, studies have linked preoperative opioid use to worse clinical outcomes after various types of surgery. Total knee and hip arthroplasty are two of the most common surgical procedures in the United States, with more than one million procedures performed each year. These findings add to those from previous studies linking chronic opioid use to worse outcomes after TKA and THA, including higher rates of complications, implant failure, and death.

"Previous studies have highlighted factors associated with poor outcomes in total joint arthroplasty, such as diabetes, chronic kidney disease, obesity, and smoking," Dr. Luu and coauthors write. "Our data suggest that preoperative opioid use may be another risk factor to take into consideration."

The study also finds that more than half of patients are exposed to opioids before TKA or THA, often for a prolonged period. The researchers write, "Although it may not be possible for certain conditions, diminishing or eliminating opioid use preoperatively would be beneficial when planning a total joint arthroplasty."

"Both readmissions and additional revision surgeries add to the cost of healthcare and are often physically and emotionally challenging for our patients," Dr. Luu comments. "As physicians, we can help our patients and the healthcare system by reducing or eliminating preoperative use in hip and knee replacement ."

Explore further: Most back pain patients halt opioid use after surgery

More information: "Preoperative Opioid Use Is Associated with Higher Readmission and Revision Rates in Total Knee and Total Hip Arthroplasty" journals.lww.com/jbjsjournal/F … ?PRID=JBJS_PR_071818

Related Stories

Most back pain patients halt opioid use after surgery

July 13, 2018
(HealthDay)—Duration of preoperative opioid use appears to be the most important predictor of sustained opioid use following back surgery, according to a study published in the June 6 issue of The Journal of Bone & Joint ...

Preoperative opioids used by 23.1 percent of surgical patients

July 17, 2018
(HealthDay)—Preoperative opioid use is reported in 23.1 percent of patients undergoing surgery, according to a study published online July 11 in JAMA Surgery.

Pre-op chronic opioid use ups poor outcomes post spinal fusion

April 2, 2018
(HealthDay)—Preoperative chronic opioid use is associated with poor outcomes and continued dependence after posterior lumbar fusion, according to a study published online March 20 in Spine.

Sustained use of opioids before spine surgery increases risk of continued use after surgery

June 8, 2018
Patients who take prescription opioids for a longer period before spinal surgery are more likely to continue using opioids several months after surgery, reports a study in the June 6, 2018, issue of The Journal of Bone & ...

Worse pain outcomes after knee replacement for patients who took opioids before surgery

May 18, 2017
Six months after knee replacement surgery, pain outcomes were not as good for patients who previously took prescription opioids, according to a study in the May 17 issue of The Journal of Bone & Joint Surgery.

Many patients continue using opioids months after joint replacement

May 31, 2016
Many patients undergoing hip or knee replacement are still taking prescription opioid pain medications up to six months after surgery, reports a study in Pain, the official publication of the International Association for ...

Recommended for you

Rapid response inpatient education boosts use of needed blood-thinning drugs

November 16, 2018
A new study designed to reach hospitalized patients at risk shows that a "real-time" educational conversation, video or leaflet can lower the missed dose rates of drugs that can prevent potentially lethal blood clots in their ...

Race plays role in regaining weight after gastric bypass surgery

November 15, 2018
African Americans and Hispanic Americans who have undergone Roux-en-Y gastric bypass (RYGB) are at greater risk to regain weight as compared to Caucasians. To date, no study has addressed the effect of race on weight regain ...

Surgery, not antibiotics, should remain first-line treatment for appendicitis: study

November 14, 2018
Treating appendicitis with antibiotics as an alternative to surgical removal of the inflamed organ was found to be more costly in the long term and result in higher rates of hospital readmissions, according to a study by ...

Study finds that in treating obesity, one size does not fit all

November 13, 2018
Analyzing data from more than 2,400 obese patients who underwent bariatric weight-loss surgery, researchers identified at least four different patient subgroups that diverge significantly in eating behaviors and rate of diabetes, ...

Surgery patients use only 1/4 of prescribed opioids, and prescription size matters

November 7, 2018
Many surgeons write prescriptions for opioid pain medications four times larger than what their patients will actually use after common operations, a new study shows.

Minimally invasive surgery associated with worse survival for women with cervical cancer compared to open hysterectomy

October 31, 2018
When comparing standard-of-care surgical options for women with early-stage cervical cancer, two studies led by researchers at The University of Texas MD Anderson Cancer Center discovered that minimally invasive radical hysterectomy ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.