Patients who take prescription opioids for more than 60 days before total knee or hip replacement surgery are at significantly higher risk of being readmitted to the hospital and of undergoing repeat joint-replacement surgery, compared with patients with no preoperative opioid use, according to a study published in The Journal of Bone & Joint Surgery.
“Opioid use should be considered yet another risk factor for surgeons and patients to consider prior to elective primary joint arthroplasty,” wrote Hue H. Luu, MD, University of Chicago, Chicago, Illinois, and colleagues.
They noted that more than half of patients in their national database study had at least 1 opioid prescription filled before undergoing total knee or hip arthroplasty (TKA or THA).
The study 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, while about 160,000 patients had 3 years of follow-up.
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 and repeat joint-replacement surgery (revision arthroplasty) within 1 to 3 years.
At the 1-year follow-up group, about 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% and 19%, respecitively.
Prolonged opioid use was associated with an increased risk of both adverse outcomes. For TKA patients, the hospital readmission rate was 4.82% among those with no preoperative opioid use versus 6.17% for those with more than 60 days of opioid use. For THA patients, the rates were 3.71% and 5.85%, respectively.
The TKA revision rate at 1 year was 1.07% for patients with no preoperative opioids versus 2.14% for those with prolonged opioid use. For THA, the revision rates were 0.38% and 1.10%, respectively.
The increased risks associated with prolonged preoperative opioid use were also significant at the 3-year follow-up. In both groups the opioid-related increases in risk remained significant after adjustment for age, sex, and comorbidity index.
The authors noted some limitations of their study, including a lack of data on the cause of repeat surgery or the reason for readmission.
“Previous studies have highlighted factors associated with poor outcomes in total joint arthroplasty, such as diabetes, chronic kidney disease, obesity, and smoking,” the authors wrote. “Our data suggest that preoperative opioid use may be another risk factor to take into consideration.”
The study also finds that more than half of patients are exposed to opioids before TKA or THA, often for a prolonged period.
“Although it may not be possible for certain conditions, diminishing or eliminating opioid use preoperatively would be beneficial when planning a total joint arthroplasty,” the authors suggested.