Abstract
BackgroundPersistent opioid use following total joint replacement (TJR) surgery is common; however, the association between pre‐surgical opioid use and surgery type has not been established. The objective of this study was to determine the association between pre‐surgery opioid use and persistent post‐surgery opioid use in TJR patients compared to other elective surgical patients.MethodsThis is a retrospective cohort study, of univariate and multinomial logistic regression of linked, de‐identified Medicare Benefits Schedule and Pharmaceutical Benefits Schedule data, adjusted for perioperative opioid use, age and sex. Oral morphine equivalents daily doses (OMEDD) were calculated and opioid use was categorized into three mutually exclusive categories for each observation window: low (0–5 OMEDD), moderate (5–10 OMEDD), high (10+ OMEDD). Persistent opioid use was defined as opioid use between 180 and 270 days after the date of surgery.ResultsPersistent opioid use was associated with older age, female gender and pre‐surgery opioid use. There was no increased risk for persistent opioid use for TJR patients compared to other surgical patients. The intensity of pre‐surgery opioid usage is strongly associated with persistent opioid use in all observed surgical patients.ConclusionsOur results suggest that many patients who use opioids prior to surgery will persist in their opioid use following surgery. No association was found between persistent opioid use and TJR surgery, but rather a risk reduction compared to other elective surgeries when associations with opioid use are controlled for. Primary care clinicians and surgeons should monitor the duration and dosage of perioperative opioid use.
Highlights
Total joint replacement (TJR) is a common surgical procedure for treating osteoarthritis of the hip and knee, a leading cause of pain and disability, and the 11th highest contributor to disability, globally.[1]
A greater understanding of the perioperative use of opioids in total joint replacement (TJR) patients is central to reducing persistent, contraindicated opioid use. These findings could inform future studies aimed at establishing the benefits and harms associated with the use of opioids in conservative management strategies, and optimum timing for TJR surgery. In this population-based study, we sought to determine the association between pre-surgery opioid use and persistent post-surgery opioid use in TJR patients compared to other elective surgical patients
To enable a 180-day lead up and a 270-day follow up period to establish whether opioids were used pre- and post-surgery, we identified all first instances of elective surgery between 1 October 2012 and 5 April 2014
Summary
Total joint replacement (TJR) is a common surgical procedure for treating osteoarthritis of the hip and knee, a leading cause of pain and disability, and the 11th highest contributor to disability, globally.[1]. Was contraindicated or delayed.[4] current Australian guidelines (2018),[3] recommend against the use of opioids at any stage of osteoarthritis, which is anticipated to be concordant with pending updated American guidelines. Persistent opioid use following total joint replacement (TJR) surgery is common; the association between pre-surgical opioid use and surgery type has not been established. The objective of this study was to determine the association between presurgery opioid use and persistent post-surgery opioid use in TJR patients compared to other elective surgical patients. The intensity of pre-surgery opioid usage is strongly associated with persistent opioid use in all observed surgical patients. Primary care clinicians and surgeons should monitor the duration and dosage of perioperative opioid use
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