BACKGROUND: Prescription opioid use is epidemic in the U.S. Recently, an association was demonstrated between preoperative opioid use and increased health-care utilization following abdominal surgeries. Given that primary total knee arthroplasty (TKA) and total hip arthroplasty (THA) are 2 of the most common surgical procedures in the U.S., we examined the association of preoperative opioid use with 30-day readmission and early revision rates. METHODS: We reviewed 2003 to 2014 data from 2 Truven Health MarketScan databases (commercial insurance and Medicare plus commercial supplemental insurance). Subjects were included if they had a Current Procedural Terminology (CPT) code for primary TKA or THA and were continuously enrolled in the database for at least 6 months prior to the index procedure. Preoperative opioid prescriptions were identified using National Drug Codes (NDCs). Rates of 30-day readmissions and revision arthroplasty were identified and compared among patients with stratified durations of preoperative opioid use in the 6 months preceding TKA or THA. RESULTS: The study included 324,154 patients in the 1-year follow-up group and 159,822 patients in the 3-year follow-up group. Opioid-naive TKA patients had a lower revision rate than did those with >60 days of preoperative opioid use (1-year cohort: 1.07% compared with 2.14%, p < 0.001; 3-year cohort: 2.58% compared with 5.00%, p < 0.001). A similar trend was noted among THA patients (1-year: 0.38% compared with 1.10%, p < 0.001; 3-year: 1.24% compared with 2.99%, p < 0.001). These trends persisted after adjusting for age, sex, and Charlson Comorbidity Index (CCI). The 30-day readmission rate after TKA or THA was significantly lower for patients with no preoperative opioid use compared with those with >60 days of preoperative opioid use (TKA: 4.82% compared with 6.17%, p < 0.001; THA: 3.71% compared with 5.85%, p < 0.001). Again, this association persisted after adjusting for age, sex, and CCI. CONCLUSIONS: Preoperative opioid use was associated with significantly increased risk of early revision and significantly increased risk of 30-day readmission after TKA and THA. This study illustrates the increased risk of poor outcomes and increased postoperative health-care utilization for patients with long-term opioid use prior to THA and TKA. LEVEL OF EVIDENCE: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
BACKGROUND: Prescription opioid use is epidemic in the U.S. Recently, an association was demonstrated between preoperative opioid use and increased health-care utilization following abdominal surgeries. Given that primary total knee arthroplasty (TKA) and total hip arthroplasty (THA) are 2 of the most common surgical procedures in the U.S., we examined the association of preoperative opioid use with 30-day readmission and early revision rates. METHODS: We reviewed 2003 to 2014 data from 2 Truven Health MarketScan databases (commercial insurance and Medicare plus commercial supplemental insurance). Subjects were included if they had a Current Procedural Terminology (CPT) code for primary TKA or THA and were continuously enrolled in the database for at least 6 months prior to the index procedure. Preoperative opioid prescriptions were identified using National Drug Codes (NDCs). Rates of 30-day readmissions and revision arthroplasty were identified and compared among patients with stratified durations of preoperative opioid use in the 6 months preceding TKA or THA. RESULTS: The study included 324,154 patients in the 1-year follow-up group and 159,822 patients in the 3-year follow-up group. Opioid-naive TKA patients had a lower revision rate than did those with >60 days of preoperative opioid use (1-year cohort: 1.07% compared with 2.14%, p < 0.001; 3-year cohort: 2.58% compared with 5.00%, p < 0.001). A similar trend was noted among THA patients (1-year: 0.38% compared with 1.10%, p < 0.001; 3-year: 1.24% compared with 2.99%, p < 0.001). These trends persisted after adjusting for age, sex, and Charlson Comorbidity Index (CCI). The 30-day readmission rate after TKA or THA was significantly lower for patients with no preoperative opioid use compared with those with >60 days of preoperative opioid use (TKA: 4.82% compared with 6.17%, p < 0.001; THA: 3.71% compared with 5.85%, p < 0.001). Again, this association persisted after adjusting for age, sex, and CCI. CONCLUSIONS: Preoperative opioid use was associated with significantly increased risk of early revision and significantly increased risk of 30-day readmission after TKA and THA. This study illustrates the increased risk of poor outcomes and increased postoperative health-care utilization for patients with long-term opioid use prior to THA and TKA. LEVEL OF EVIDENCE: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Authors: Ruiqi Tang; Katherine B Santosa; Joceline V Vu; Lewei A Lin; Yen-Ling Lai; Michael J Englesbe; Chad M Brummett; Jennifer F Waljee Journal: Ann Surg Date: 2022-01-01 Impact factor: 12.969
Authors: Jeffrey B Stambough; Ryan Hui; Eric R Siegel; Paul K Edwards; C Lowry Barnes; Simon C Mears Journal: J Arthroplasty Date: 2020-08-04 Impact factor: 4.757
Authors: Corey C Spencer; Jeremiah A Pflederer; Jacob M Wilson; Alexander M Dawes; Michael B Gottschalk; Eric R Wagner Journal: JSES Int Date: 2021-04-03
Authors: Samuel T Kunkel; James J Gregory; Matthew J Sabatino; Tracy M Borsinger; Yale A Fillingham; David S Jevsevar; Wayne E Moschetti Journal: Arthroplast Today Date: 2021-07-09