Preop opioids lead to poorer outcomes after arthroplasty

  • Blevins Peratikos M & al.
  • Pain Med
  • 23 May 2019

  • International Clinical Digest
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Takeaway

  • Patients undergoing orthopedic surgery for total hip, knee, and shoulder arthroplasty and similar procedures in the U.S. who used opioids preoperatively had significantly higher risks of surgical site infections, nonhome discharge, readmission within 30 days, surgical revision, and long-term opioid use compared with those who did not use opioids before surgery.

Why this matters

  • Up to 40% of people undergoing elective arthroplasty have used opioids preoperatively.

Study design

  • Study of 34,792 patients (age, >18 years) who underwent elective total joint replacement surgery.
  • Funding: axialHealthcare.

Key results

  • 17.4% of patients used preoperative opioid with median morphine equivalent dose of 32 mg/day.
  • Preoperative opioid use vs no use was associated with:
    • Longer hospital stays: 3.98 vs 3.87 days; incidence rate ratio, 1.03; P<.001>
    • Higher nonhome discharge: OR, 1.10; P=.048;
    • Higher 30-day readmission: OR, 1.43; P<.001>
    • Higher 90-day surgical site infection: HR, 1.35; P<.001>
    • Higher 18-month surgical revision: HR, 1.36; P<.001 and>
    • Lower 18-month opioid cessation: HR, 0.34; P<.001.>

Limitations

  • Retrospective design.

Coauthored with Antara Ghosh, PhD