Alfred C Kuo1, Karthik Raghunathan2, Alain M Lartigue3, William E Bryan4, Marc J Pepin4, Steven Takemoto5, Arthur W Wallace3. 1. Department of Orthopaedic Surgery, University of California, San Francisco, CA; Orthopaedic Section, San Francisco Veterans Affairs Medical Center, San Francisco, CA. 2. Department of Anesthesiology, Duke University Medical Center, Durham, NC; The Patient Safety Center of Inquiry, Durham Veterans Affairs Medical Center, Durham, NC. 3. Anesthesiology Service, San Francisco Veterans Affairs Medical Center, San Francisco, CA. 4. Pharmacy Service, Durham Veterans Affairs Health Care System, Durham, NC. 5. The Patient Safety Center of Inquiry, Durham Veterans Affairs Medical Center, Durham, NC; Anesthesiology Service, San Francisco Veterans Affairs Medical Center, San Francisco, CA.
Abstract
BACKGROUND: In the United States, opioids are commonly prescribed to treat knee pain after total knee arthroplasty (TKA). While surgery leads to decreased pain in most patients, a sizable minority continue to experience severe pain and consume opioids chronically after TKA. We sought to determine the population-level effect of TKA on opioid consumption by detailing the pattern of opioid prescriptions before and after surgery. METHODS: We retrospectively identified US Veterans Health Administration TKA patients from 2010 to 2015. Outpatient opioid prescriptions were identified from 18 months before to 18 months after surgery, and mean daily opioid doses were calculated. Our primary end point was the achievement of opioid-freedom, defined as a period of at least 6 months without opioids. We compared the percentage of patients who were opioid-free preoperatively to the percentage who were opioid-free 18 months after surgery (no prescriptions after postoperative month 12). We identified factors associated with opioid-freedom. RESULTS: In a cohort of 33,927 patients, 41% were opioid-free in the month before surgery compared to 54% 18 months after surgery (P < .001). Preoperative freedom from opioids (odds ratio, 4.59; 95% confidence interval, 4.34 to 4.85; P < .001) was more strongly associated with postoperative freedom from opioids than patient medical and social factors. CONCLUSION: TKA was associated with an increase in postoperative freedom from opioids. Low preoperative dose of opioids was more strongly associated with postoperative opioid-freedom than patient characteristics, suggesting that opioid prescription patterns are a chief driver of opioid use after surgery. LEVEL OF EVIDENCE III: Retrospective cohort study. Published by Elsevier Inc.
BACKGROUND: In the United States, opioids are commonly prescribed to treat knee pain after total knee arthroplasty (TKA). While surgery leads to decreased pain in most patients, a sizable minority continue to experience severe pain and consume opioids chronically after TKA. We sought to determine the population-level effect of TKA on opioid consumption by detailing the pattern of opioid prescriptions before and after surgery. METHODS: We retrospectively identified US Veterans Health Administration TKA patients from 2010 to 2015. Outpatient opioid prescriptions were identified from 18 months before to 18 months after surgery, and mean daily opioid doses were calculated. Our primary end point was the achievement of opioid-freedom, defined as a period of at least 6 months without opioids. We compared the percentage of patients who were opioid-free preoperatively to the percentage who were opioid-free 18 months after surgery (no prescriptions after postoperative month 12). We identified factors associated with opioid-freedom. RESULTS: In a cohort of 33,927 patients, 41% were opioid-free in the month before surgery compared to 54% 18 months after surgery (P < .001). Preoperative freedom from opioids (odds ratio, 4.59; 95% confidence interval, 4.34 to 4.85; P < .001) was more strongly associated with postoperative freedom from opioids than patient medical and social factors. CONCLUSION: TKA was associated with an increase in postoperative freedom from opioids. Low preoperative dose of opioids was more strongly associated with postoperative opioid-freedom than patient characteristics, suggesting that opioid prescription patterns are a chief driver of opioid use after surgery. LEVEL OF EVIDENCE III: Retrospective cohort study. Published by Elsevier Inc.
Entities:
Keywords:
opioids; pain; prescription; total knee arthroplasty; veteran
Authors: Kevin Berardino; Austin H Carroll; Robert Ricotti; Daniel Popovsky; Matthew D Civilette; Ivan Urits; Omar Viswanath; William F Sherman; Alan D Kaye Journal: Orthop Rev (Pavia) Date: 2022-08-30
Authors: Ralph Ward; David Taber; Haley Gonzales; Mulugeta Gebregziabher; William Basco; Jenna McCauley; Patrick Mauldin; Sarah Ball Journal: Knee Surg Relat Res Date: 2022-04-05