Opioid Use After Total Knee Arthroplasty: Trends and Risk Factors for Prolonged Use

BackgroundTotal knee arthroplasty (TKA) is associated with a high incidence of continued opioid use beyond the expected period of recovery. The aim of this study was to determine the influence of inpatient opioid consumption on the development of persistent use.MethodsOpioid-naïve patients undergoing primary, uncomplicated TKA were included in a prospective, observational study at a single institution. Postoperatively, opioids were prescribed by orthopedic advanced practitioners or resident physicians and administered by registered nurses. Individual inpatient prescriptions were adjusted, as needed, to facilitate optimal recovery conditions. Average hourly inpatient opioid consumption was calculated from total usage between midnight on the day of surgery until the time of hospital discharge. Persistent opioid use was defined as a prescription refill written by the orthopedic surgeon at the 6-week surgical follow-up visit. A multivariable regression model was used to identify independent risk factors associated with persistent use.ResultsA total of 351 patients were included in the analysis. Persistent opioid use was identified in 17.4% (61) of patients overall. A history of alcohol abuse (OR 7.80; 95% CI 2.13 to 28.55, p=0.002) was identified as an independent risk factor. Inpatient opioid consumption in the top quartile (equivalent to more than 10 mg of oxycodone every 4 hours) was not found to be associated with persistent use.ConclusionLarger amounts of opioid consumed in the hospital following uncomplicated, primary TKA may not be associated with an increased risk of persistent use at 6 weeks among opioid-naïve patients. Patients may have unique risk factors for prolonged opioid use that may not necessarily be apparent in the early postoperative period.

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Risk Factors of Opioid use Associated with an Enhanced-Recovery Programme after Total Knee Arthroplasty

10.21203/rs.3.rs-241590/v1 ◽

2021 ◽

Author(s):

Guorui Cao ◽

Fuxing Pei

Keyword(s):

Risk Factors ◽

Total Knee Arthroplasty ◽

Tranexamic Acid ◽

Knee Arthroplasty ◽

Protective Factor ◽

Operative Time ◽

Enhanced Recovery ◽

Opioid Use ◽

Enhanced Recovery Programme ◽

Total Knee

Abstract Background: The relationship between total knee arthroplasty (TKA) and postoperative opioid use is poorly studied. The aim of the study is to examine the prevalence and risk factors for opioid use with an enhanced-recovery programme after primary TKA.Methods: We identified 361 patients undergoing TKA, and separated those on the basis of whether to receive opioid use after surgery. Multivariate logistic regression model was used to identify independent risk factors for opioid use after primary TKA. Length of stay (LOS) and postoperative complications were recorded and compared.Results: The prevalence of opioid use after primary TKA was 23.0%. Significant risk factor were more operative time (OR [odds ratio] = 1.017, 95% CI [confidence interval] = 1.001 to 1.032, p = 0.034) and protective factor was tranexamic acid use (OR= 0.355, 95% CI = 0.161 to 0.780, p = 0.010). In addition, the LOS was longer in opioid group (p < 0.05).Conclusion: Considering the adverse health effects of opioid use, strategies need to be developed to prevent persistent opioid use. Reducing operative time and application of tranexamic acid could lower the risk of opioid use with an enhanced-recovery programme after primary TKA.

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Risk factors of opioid use associated with an enhanced-recovery programme after total knee arthroplasty

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04937-8 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Guorui Cao ◽

Shiqi Xiang ◽

Minglu Yang ◽

Songtao Quan ◽

Junna Yao ◽

...

Keyword(s):

Risk Factors ◽

Total Knee Arthroplasty ◽

Tranexamic Acid ◽

Knee Arthroplasty ◽

Protective Factor ◽

Operative Time ◽

Enhanced Recovery ◽

Opioid Use ◽

Enhanced Recovery Programme ◽

Total Knee

Abstract Background Characterizing the impacts of postoperative opioid use on total knee arthroplasty (TKA) patients may help optimize the pain management after TKA. The aim of the study is to examine the prevalence and risk factors for opioid use with an enhanced-recovery programme after primary TKA. Methods We identified 361 patients undergoing TKA, and separated those on the basis of whether to receive opioid use after surgery. Themultivariate logistic regression model was used to identify independent risk factors for opioid use after primary TKA. Length of stay (LOS) and postoperative complications were also recorded and compared. Results The prevalence of opioid use after primary TKA was 23.0%. The significant risk factor was the longer operative time (OR [odds ratio] = 1.017, 95% CI [confidence interval] = 1.001 to 1.032, p = 0.034) and the protective factor was the utilization of tranexamic acid(OR= 0.355, 95% CI = 0.161 to 0.780, p = 0.010). In addition, the LOS was longer in opioid group (p < 0.05). Conclusion Considering the adverse health effects of opioid use, strategies need to be developed to prevent persistent opioid use after TKA. Reducing operative time and the application of tranexamic acid could lower the risk of opioid use with an enhanced-recovery programme after primary TKA.

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SLeep and OPioid UsE in Patients Undergoing Total Knee Arthroplasty

Case Medical Research ◽

10.31525/ct1-nct04247646 ◽

2020 ◽

Author(s):

Keyword(s):

Total Knee Arthroplasty ◽

Knee Arthroplasty ◽

Opioid Use ◽

Total Knee

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Total knee arthroplasty is associated with greater immediate post-surgical pain and opioid use than total hip arthroplasty

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-021-03951-8 ◽

2021 ◽

Author(s):

David N. Kugelman ◽

Siddharth A. Mahure ◽

James E. Feng ◽

Joshua C. Rozell ◽

Ran Schwarzkopf ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Total Hip Arthroplasty ◽

Knee Arthroplasty ◽

Hip Arthroplasty ◽

Opioid Use ◽

Total Hip ◽

Surgical Pain ◽

Total Knee

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Impact of Preoperative Opioid Use on Patient-Reported Outcomes after Revision Total Knee Arthroplasty: A Propensity Matched Analysis

The Journal of Knee Surgery ◽

10.1055/s-0041-1729966 ◽

2021 ◽

Author(s):

Eitan Ingall ◽

Christian Klemt ◽

Christopher M. Melnic ◽

Wayne B. Cohen-Levy ◽

Venkatsaiakhil Tirumala ◽

...

Keyword(s):

Total Knee Arthroplasty ◽

Propensity Score ◽

Knee Arthroplasty ◽

Patient Reported Outcomes ◽

Opioid Use ◽

Absolute Increase ◽

Patient Reported ◽

Total Knee ◽

Opioid Users ◽

Revision Tka

AbstractThis is a retrospective study. Prior studies have characterized the deleterious effects of narcotic use in patients undergoing primary total knee arthroplasty (TKA). While there is an increasing revision arthroplasty burden, data on the effect of narcotic use in the revision surgery setting remain limited. Our aim was to characterize the effect of active narcotic use at the time of revision TKA on patient-reported outcome measures (PROMs). A total of 330 consecutive patients who underwent revision TKA and completed both pre- and postoperative PROMs was identified. Due to differences in baseline characteristics, 99 opioid users were matched to 198 nonusers using the nearest-neighbor propensity score matching. Pre- and postoperative knee disability and osteoarthritis outcome score physical function (KOOS-PS), patient reported outcomes measurement information system short form (PROMIS SF) physical, PROMIS SF mental, and physical SF 10A scores were evaluated. Opioid use was identified by the medication reconciliation on the day of surgery. Propensity score–matched opioid users had significantly lower preoperative PROMs than the nonuser for KOOS-PS (45.2 vs. 53.8, p < 0.01), PROMIS SF physical (37.2 vs. 42.5, p < 0.01), PROMIS SF mental (44.2 vs. 51.3, p < 0.01), and physical SF 10A (34.1 vs. 36.8, p < 0.01). Postoperatively, opioid-users demonstrated significantly lower scores across all PROMs: KOOS-PS (59.2 vs. 67.2, p < 0.001), PROMIS SF physical (43.2 vs. 52.4, p < 0.001), PROMIS SF mental (47.5 vs. 58.9, p < 0.001), and physical SF 10A (40.5 vs. 49.4, p < 0.001). Propensity score–matched opioid-users demonstrated a significantly smaller absolute increase in scores for PROMIS SF Physical (p = 0.03) and Physical SF 10A (p < 0.01), as well as an increased hospital length of stay (p = 0.04). Patients who are actively taking opioids at the time of revision TKA report significantly lower preoperative and postoperative outcome scores. These patients are more likely to have longer hospital stays. The apparent negative effect on patient reported outcomes after revision TKA provides clinically useful data for surgeons in engaging patients in a preoperative counseling regarding narcotic use prior to revision TKA to optimize outcomes.

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