James Lendrum1, Tyler Freeman1, Michael R Dayton1, Craig Hogan1, Andrew Park1, Jeri E Forster2,3, Marcus Greatens1. 1. University of Colorado, Department of Orthopedics; 12631 E. 17th Avenue, Mail Stop B202 Aurora, CO, 80045, USA. 2. University of Colorado, Department of Physical Medicine and Rehabilitation; 12631 E. 17th Avenue, Room 1201G, Aurora, CO, 80045, USA. 3. Veteran's Health Administration Rocky Mountain Mental Illness, Research, Education and Clinical Center for Suicide Prevention, 1700 N. Wheeling St., Aurora, CO, 80045, USA.
Abstract
BACKGROUND: The aim of our study was to evaluate whether an association exists between body mass index (BMI) category and post-operative opioid requirements among primary total joint arthroplasty (TJA) patients. METHODS: We retrospectively reviewed all primary unilateral total hip and total knee arthroplasty (THA/TKA, respectively) cases performed over a two-year period. We evaluated whether a relationship exists between five BMI categories (≤24.9, 25-29.9, 30-34.9, 35-39.9, ≥40) and morphine milligram equivalent (MME) use for total in-hospital, daily in-hospital, and total during six weeks post-discharge. Secondary outcomes included relationship with length of stay, discharge location, opioid refill rate, and pre-operative opioid usage. RESULTS: For all patients undergoing primary TJA, increasing BMI resulted in an incremental increase in post-operative total in-hospital MME use for each successive BMI category when compared to those with BMI ≤24.9 (p < 0.05). This association held true for the THA subset. Within the cohort as a whole, higher categories of BMI were associated with increased length of stay (35-39.9, ≥40), higher odds of needing a refill (30-34.9, 35-39.9, ≥40), and higher odds of discharging to a rehab facility (25-29.9, ≥40) (p < 0.05). There was an increasing proportion of pre-operative opioid use as BMI category increased (p < 0.0001). DISCUSSION/ CONCLUSION: BMI category is associated with increased in-hospital opioid requirements among primary TJA patients. Such findings are an important step to better understanding pain control expectations and can help facilitate development of opioid reduction strategies.
BACKGROUND: The aim of our study was to evaluate whether an association exists between body mass index (BMI) category and post-operative opioid requirements among primary total joint arthroplasty (TJA) patients. METHODS: We retrospectively reviewed all primary unilateral total hip and total knee arthroplasty (THA/TKA, respectively) cases performed over a two-year period. We evaluated whether a relationship exists between five BMI categories (≤24.9, 25-29.9, 30-34.9, 35-39.9, ≥40) and morphine milligram equivalent (MME) use for total in-hospital, daily in-hospital, and total during six weeks post-discharge. Secondary outcomes included relationship with length of stay, discharge location, opioid refill rate, and pre-operative opioid usage. RESULTS: For all patients undergoing primary TJA, increasing BMI resulted in an incremental increase in post-operative total in-hospital MME use for each successive BMI category when compared to those with BMI ≤24.9 (p < 0.05). This association held true for the THA subset. Within the cohort as a whole, higher categories of BMI were associated with increased length of stay (35-39.9, ≥40), higher odds of needing a refill (30-34.9, 35-39.9, ≥40), and higher odds of discharging to a rehab facility (25-29.9, ≥40) (p < 0.05). There was an increasing proportion of pre-operative opioid use as BMI category increased (p < 0.0001). DISCUSSION/ CONCLUSION: BMI category is associated with increased in-hospital opioid requirements among primary TJA patients. Such findings are an important step to better understanding pain control expectations and can help facilitate development of opioid reduction strategies.
Authors: Maureen K Dwyer; Cathrine M Tumpowsky; Nancy L Hiltz; JoAnn Lee; William L Healy; Hany S Bedair Journal: J Arthroplasty Date: 2017-10-16 Impact factor: 4.757
Authors: Christopher R Abrecht; Marise Cornelius; Albert Wu; Robert N Jamison; David Janfaza; Richard D Urman; Claudia Campbell; Michael Smith; Jennifer Haythornthwaite; Robert R Edwards; Kristin L Schreiber Journal: Pain Med Date: 2019-01-01 Impact factor: 3.750
Authors: Jonathan R Dattilo; Agnes D Cororaton; Jeanine M Gargiulo; James F McDonald; Henry Ho; William G Hamilton Journal: J Arthroplasty Date: 2020-05-04 Impact factor: 4.757
Authors: Gino M M J Kerkhoffs; Elvire Servien; Warren Dunn; Diane Dahm; Jos A M Bramer; Daniel Haverkamp Journal: J Bone Joint Surg Am Date: 2012-10-17 Impact factor: 5.284