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15-08-2019 | Total knee replacement | News

Preoperative opioid use linked to adverse outcomes after knee replacement

medwireNews: Among people with osteoarthritis or rheumatoid arthritis who undergo total knee replacement (TKR), continuous preoperative opioid use is associated with an increased risk for adverse outcomes, study findings suggest.

Seoyoung Kim (Brigham and Women’s Hospital, Boston, Massachusetts, USA) analyzed US Medicare claims data from 316,593 patients aged an average of 73.9 years, of whom 7.2% used opioids continuously (≥1 prescription/month for 1 year), 51.0% used opioids intermittently (≥1 prescription in 1 year but not continuous use), and 41.7% were opioid-naïve.

As reported in JAMA Network Open, 0.49% of 22,895 continuous opioid users required a revision operation within 30 days of TKR, compared with 0.22% of 132,187 opioid-naïve patients, translating into a significant 63% increased risk for revision surgery among continuous opioid users in a model adjusting for age, sex, frailty, medication use, and other factors. People who used opioids intermittently had an intermediate rate of revision surgery within 30 days, at 0.32%.

Kim and team also found that rates of opioid overdose were significantly higher in the continuous opioid use versus never use group in the fully adjusted model, as were rates of vertebral fracture.

The study authors observed a similar pattern of results for in-hospital mortality, with rates of 0.12%, 0.10%, and 0.06% in the continuous use, intermittent use, and opioid-naïve groups, respectively, as well as for 30-day hospital readmission risk, with corresponding rates of 7.30%, 5.59%, and 4.60%.

There was a significantly higher risk for in-hospital mortality and 30-day readmission among patients in the continuous use versus opioid-naïve group in unadjusted analyses (hazard ratio=1.95 and 1.47, respectively), but the association was no longer statistically significant in the fully adjusted analysis.

Discussing the implications of the loss of significance in the adjusted analysis, the researchers say that “differences in the baseline risk profile between continuous opioid users and opioid-naive patients may contribute more” to the association than opioid use itself, meaning that “it may be not possible to reduce the rate of some of the short-term complications after TKR even if use of opioids is minimized.”

Nonetheless, they believe that “even if it is not a truly independent risk factor, preoperative long-term use of opioids may be a marker with an unfavorable risk profile leading to poor postoperative outcome.”

And the team concludes: “As such, evaluation of patients’ preoperative opioid use patterns may be helpful in planning a more rigorous monitoring strategy after a common elective surgical procedure, such as TKR.”

By Claire Barnard

medwireNews is an independent medical news service provided by Springer Healthcare. © 2019 Springer Healthcare part of the Springer Nature group

JAMA Netw Open 2019; 2: e198061

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