A new study from the Journal of Bone & Joint Surgery found preoperative opioid use is associated with higher readmission and revision rates in total knee and hip arthroplasties.
Researchers examined data from patients in two groups that included 324,154 patients who were followed up with after one year postoperative and 159,822 patients who were followed up with after three years. The data was collected between 2003 and 2014.
Here are the key findings:
1. For those in the one-year follow up group, 51 percent of TKA patients and 56 percent of THA patients had one or more opioid prescriptions filled six months before the procedure. Sixteen percent of TKA patients had prolonged preoperative opioid use lasting longer than 60 days, and 19 percent for THA patients.
2. Higher rates of readmission and revision were associated with preoperative opioid use in the one-year follow up group. The readmission rate was 4.82 percent among TKA patients with no preoperative opioid use, compared to 6.17 percent for those who had used opioids for more than 60 days. For THA patients, the rates were 3.71 versus 5.85 percent, respectively.
3. In the first year following TKA, 1.07 percent of patients who had not taken opioids underwent revision, compared with 2.14 percent of the patients with more than 60 days of preoperative opioid use. Similarly, in the first year following THA, 0.38 percent of patients who had not taken opioids required revision, compared with 1.10 percent of the patients with more than 60 days of preoperative opioid use.
3. In the three-year follow up group, 49.1 percent of the TKA patients and 44.3 percent of the THA patients had no opioid prescriptions. For the TKA patients, 15.6 percent had prolonged opioid use preoperatively, compared to 18.4 percent for the THA patients.
4. The three-year ground had higher rates of readmission and revision. For those who had not taken opioids preoperatively, 2.58 percent of TKA patients required revision while 5 percent of those who had used opioids preoperatively required revision. For THA patients, 1.24 percent of patients who had not taken opioids required revision, compared with 2.99 percent of the patients with more than 60 days of preoperative opioid use.
“Although increased attention has been paid to the opioid epidemic in the U.S. in recent years, our findings highlight that opioid use should be considered yet another risk factor for surgeons and patients to consider prior to undergoing elective primary joint arthroplasty,” the authors concluded.