Prolonged Opioid Use Before TJA Increases the Risk of Poor Outcomes
Compared with patients with no preoperative opioid use, patients who take prescription opioids for more than 60 days before total knee arthroplasty (TKA) or total hip arthroplasty (THA) are at a significantly higher risk of being readmitted to the hospital after surgery and of needing a revision procedure, according to a study published in The Journal of Bone & Joint Surgery.
The study from The University of Chicago included approximately 324,000 patients who underwent TKA (n=233,000) or THA (n=91,000) between 2003 and 2014. All patients had at least 1 year of follow-up data available, while approximately 160,000 patients had 3 years of follow-up data.
Patients were identified from a national database that included both private insurance and Medicare data. Preoperative opioid use was assessed as a risk factor for 2 major adverse outcomes:
- Readmission to the hospital within 30 days of discharge
- Revision procedure within 1 to 3 years after the primary procedure
In the 1-year follow-up group, 51% of TKA patients and 56% of THA patients had 1 or more opioid prescriptions filled in the 6 months before the procedure. Rates of prolonged preoperative opioid use – more than 60 days – were 16% for TKA patients and 19% for THA patients.
Prolonged opioid use was associated with an increased risk of both adverse outcomes. In the 1-year follow-up group:
- The hospital readmission rate was 4.82% percent among TKA patients with no preoperative opioid use versus 6.17% for those with more than 60 days of opioid use before surgery.
- The rate of revision TKA was 1.07% for patients with no preoperative opioids versus 2.14% for those with prolonged opioid use.
- The hospital readmission rate was 3.71% among THA patients with no preoperative opioid use versus 5.85% for those with more than 60 days of opioid use before surgery.
- The rate of revision THA was 0.38% for patients with no preoperative opioids versus 1.10% for those with prolonged opioid use.
The increased risks associated with prolonged preoperative opioid use were also significant in the 3-year follow-up group.
In both groups the opioid-related increases in risk remained significant after adjustment for age, sex, and Charlson Comorbidity Index.
The authors note some limitations of their study, including a lack of data on the cause of repeat surgery or the reason for readmission.
Total knee and hip arthroplasty are 2 of the most common surgical procedures in the US, with more than 1 million procedures performed each year. The findings of this study add to those from previous studies linking chronic opioid use to worse outcomes after TKA and THA, including higher rates of complications, implant failure, and death.
Weick J, Bawa H, Dirschl DR, Luu HH. Preoperative opioid use is associated with higher readmission and revision rates in total knee and total hip arthroplasty. J Bone Joint Surg Am. 2018. 100(14):1171-6. doi: 10.2106/JBJS.17.01414.