Kelvin Kim1, Kevin K Chen1,2, Mackenzie Roof1, Afshin A Anoushiravani1, Jonathan Vigdorchik1, Ran Schwarzkopf1. 1. Department of Orthopaedic Surgery, NYU Langone Medical Center, Langone Orthopedic Hospital, 301 E 17th St., New York, NY, 10003, USA. 2. Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA.
Abstract
BACKGROUND: Perioperative opioid use is becoming an increasingly concerning topic in total joint arthroplasty (TJA). The current study aims to add to the paucity of prior studies that have detailed perioperative opioid use patterns and the effects of preoperative chronic opioid use among a cohort of total hip arthroplasty (THA) patients. METHODS: A retrospective analysis of 256 consecutive patients who underwent a THA at our institution between February 2016 and June 2016 was performed. Two cohorts were compared: patients deemed 1) preoperative chronic opioid users, and 2) non-chronic users. Variables compared included baseline characteristics, quality metrics, and patients' opioid use histories 3 months prior to surgery and 6 months following surgery. RESULTS: Of the 256 patients, 54 (21.1%) patients were identified as preoperative chronic opioid users. Baseline characteristics including age, gender, BMI, and ASA scores were similar between both cohorts. Discharge disposition, value-based purchasing (VBP) costs, length of stay (LOS), emergency room visits, and postoperative office visits were similar between the two cohorts. Readmission rates (30-day, 90-day, and 6-month) were significantly higher (p < 0.05) in the chronic opioid users cohort. By the 6-month postoperative time period, chronic opioid users were consuming approximately 100-times the morphine equivalents than non-chronic users. CONCLUSIONS: The current study demonstrates that a substantial proportion of preoperative chronic opioid users continue to consume large amounts of opioids up to 6-months following THA surgery. Furthermore, preoperative chronic use is significantly associated with poorer quality outcomes, specifically with respect to readmission rates. LEVEL OF EVIDENCE: Level II, Prognostic Study.
BACKGROUND: Perioperative opioid use is becoming an increasingly concerning topic in total joint arthroplasty (TJA). The current study aims to add to the paucity of prior studies that have detailed perioperative opioid use patterns and the effects of preoperative chronic opioid use among a cohort of total hip arthroplasty (THA) patients. METHODS: A retrospective analysis of 256 consecutive patients who underwent a THA at our institution between February 2016 and June 2016 was performed. Two cohorts were compared: patients deemed 1) preoperative chronic opioid users, and 2) non-chronic users. Variables compared included baseline characteristics, quality metrics, and patients' opioid use histories 3 months prior to surgery and 6 months following surgery. RESULTS: Of the 256 patients, 54 (21.1%) patients were identified as preoperative chronic opioid users. Baseline characteristics including age, gender, BMI, and ASA scores were similar between both cohorts. Discharge disposition, value-based purchasing (VBP) costs, length of stay (LOS), emergency room visits, and postoperative office visits were similar between the two cohorts. Readmission rates (30-day, 90-day, and 6-month) were significantly higher (p < 0.05) in the chronic opioid users cohort. By the 6-month postoperative time period, chronic opioid users were consuming approximately 100-times the morphine equivalents than non-chronic users. CONCLUSIONS: The current study demonstrates that a substantial proportion of preoperative chronic opioid users continue to consume large amounts of opioids up to 6-months following THA surgery. Furthermore, preoperative chronic use is significantly associated with poorer quality outcomes, specifically with respect to readmission rates. LEVEL OF EVIDENCE: Level II, Prognostic Study.
Authors: Stephen W Yu; Alessandra L Szulc; Sharon L Walton; Roy I Davidovitch; Joseph A Bosco; Richard Iorio Journal: J Arthroplasty Date: 2016-01-21 Impact factor: 4.757
Authors: Robert Pivec; Kimona Issa; Qais Naziri; Bhaveen H Kapadia; Peter M Bonutti; Michael A Mont Journal: Int Orthop Date: 2014-02-27 Impact factor: 3.075
Authors: Denise Boudreau; Michael Von Korff; Carolyn M Rutter; Kathleen Saunders; G Thomas Ray; Mark D Sullivan; Cynthia I Campbell; Joseph O Merrill; Michael J Silverberg; Caleb Banta-Green; Constance Weisner Journal: Pharmacoepidemiol Drug Saf Date: 2009-12 Impact factor: 2.890
Authors: Andrew A Monte; Kennon J Heard; Jason A Hoppe; Vasilis Vasiliou; Frank J Gonzalez Journal: J Clin Pharmacol Date: 2014-07-28 Impact factor: 3.126
Authors: Nicholas L Ramos; Raj J Karia; Lorraine H Hutzler; Aaron M Brandt; James D Slover; Joseph A Bosco Journal: J Arthroplasty Date: 2013-10-30 Impact factor: 4.757
Authors: Kevin Berardino; Austin H Carroll; Daniel Popovsky; Robert Ricotti; Matthew D Civilette; William F Sherman; Alan D Kaye Journal: Orthop Rev (Pavia) Date: 2022-05-31
Authors: Vivek Singh; Alex Tang; Thomas Bieganowski; Utkarsh Anil; William Macaulay; Ran Schwarzkopf; Roy I Davidovitch Journal: World J Orthop Date: 2022-08-18