Abstract
Preoperative opioid use has been shown to increase the risk for complications following total joint arthroplasty (TJA); however, these studies have not always accounted for differences in co-morbidities and socio-demographics between patients that use opioids and those that do not. They have also not accounted for the variation in degree of pre-operative use. The objective of this study was to determine if preoperative opioid use is associated with risk for surgical complications after TJA, and if this association varied by degree of use. Population-based retrospective cohort study. Older adult patients undergoing primary TJA of the hip, knee and shoulder for osteoarthritis between 2002 and 2015 in Ontario, Canada were identified. Using accepted definitions, patients were stratified into three groups according to their preoperative opioid use: no use, intermittent use and chronic use. The primary outcome was the occurrence of a composite surgical complication (surgical site infection, dislocation, revision arthroplasty) or death within a year of surgery. Intermittent and chronic users were matched separately to non-users in a 1:1 ratio, matching on TJA type plus a propensity score incorporating patient and provider factors. Overall, 108,067 patients were included in the study; 10% (N = 10,441) used opioids on a chronic basis before surgery and 35% (N = 37,668) used them intermittently. After matching, chronic pre-operative opioid use was associated with an increased risk for complications after TJA (HR 1.44, p = 0.001) relative to non-users. Overall, less than half of patients undergoing TJA used opioids in the year preceding surgery; the majority used them only intermittently. While chronic pre-operative opioid use is associated with an increased risk for complications after TJA, intermitted pre-operative use is not.
Highlights
Preoperative opioid use has been shown to increase the risk for complications following total joint arthroplasty (TJA); these studies have not always accounted for differences in co-morbidities and socio-demographics between patients that use opioids and those that do not
Many patients with refractory arthritis pain will progress to total joint arthroplasty (TJA), which is generally successful at reducing pain and improving function, for hip arthritis
We used a large population database to identify patients undergoing TJA of the hip, knee and shoulder, and used medication records to stratify these patients according to their pattern of opioid use based on accepted definitions: non-users, intermittent users, and chronic users
Summary
Preoperative opioid use has been shown to increase the risk for complications following total joint arthroplasty (TJA); these studies have not always accounted for differences in co-morbidities and socio-demographics between patients that use opioids and those that do not. In recent years evidence has emerged to suggest that pre-operative opioid use negatively impacts outcomes and increases early complication rates following T JA4–8 Both OARSI and the AAOS, among some other groups, have recommended against the use of opioids for arthritis p ain[9,10]. There are obvious benefits to decreasing opioid use among older patients, one clear criticism of the research to date is that it fails to stratify patients by how they use narcotics Up until this point, pre-operative opioid use has been viewed in a binary way—use or non-use. We used a large population database to identify patients undergoing TJA of the hip, knee and shoulder, and used medication records to stratify these patients according to their pattern of opioid use based on accepted definitions: non-users, intermittent users, and chronic users. Our hypothesis was that chronic pre-operative use of opioids would increase complication risk following TJA, but intermittent use would not
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