CORR Insights(®): Preoperative Opioid Misuse is Associated With Increased Morbidity and Mortality After Elective Orthopaedic Surgery.

Abstract

N arcotics are a necessity for patients in the setting of orthopaedic surgery. Many elective orthopaedic procedures require rehabilitation and therapy to maximize outcomes and assist with the return of function. Narcotics during rehabilitation allow a level of intensity and progress that would not be attainable otherwise. At the same time, the side effects of narcotics and the potential for abuse are well known and are a cause of concern for all orthopaedic surgeons. Management of narcotic use in the postoperative period requires constant vigilance in order to decrease dosing appropriately as recovery progresses. Additionally, well-intentioned primary care physicians, trying to help with musculoskeletal pain, manage some patients preoperatively with narcotics; some of these patients develop narcotic dependence. Managing postoperative pain in these patients is much more difficult, and intuitively, most orthopaedic surgeons understand this. Unfortunately, the number of narcotic prescriptions has increased dramatically during the last several years, and this represents a growing global problem [1, 2]. The article by Menendez et al. details the rise in narcotic dependence and describes the effect of preoperative narcotic use on postoperative outcomes. Using a healthcare utilization database they demonstrate higher complications and worse outcomes for patients undergoing elective orthopaedic surgery in the inpatient setting including prolonged length of stay, increased need for mechanical ventilation, and death. They also demonstrate an increase of 152% in the incidence of narcotic dependence in patients presenting for elective orthopaedic procedures from 2002 to 2011. Even at their highest measured level, the study authors found 0.24% (1 in 425) of patients had opioid dependence. It is fair to say that this, likely, grossly underestimates the true incidence.