Trends and predictors of opioid use after total knee and total hip arthroplasty

Abstract

Few studies have assessed postoperative trends in opioid cessation and predictors of persistent opioid use after total knee arthroplasty (TKA) and total hip arthroplasty (THA). Preoperatively, 574 TKA and THA patients completed validated, self-report measures of pain, functioning, and mood and were longitudinally assessed for 6 months after surgery. Among patients who were opioid naive the day of surgery, 8.2% of TKA and 4.3% of THA patients were using opioids at 6 months. In comparison, 53.3% of TKA and 34.7% of THA patients who reported opioid use the day of surgery continued to use opioids at 6 months. Patients taking >60 mg oral morphine equivalents preoperatively had an 80% likelihood of persistent use postoperatively. Day of surgery predictors for 6-month opioid use by opioid-naive patients included greater overall body pain (P = 0.002), greater affected joint pain (knee/hip) (P = 0.034), and greater catastrophizing (P = 0.010). For both opioid-naive and opioid users on the day of surgery, decreases in overall body pain from baseline to 6 months were associated with decreased odds of being on opioids at 6 months (adjusted odds ratio [aOR] = 0.72, P = 0.050; aOR = 0.62, P = 0.001); however, change in affected joint pain (knee/hip) was not predictive of opioid use (aOR = 0.99, P = 0.939; aOR = 1.00, P = 0.963). In conclusion, many patients taking opioids before surgery continue to use opioids after arthroplasty and some opioid-naive patients remained on opioids; however, persistent opioid use was not associated with change in joint pain. Given the growing concerns about chronic opioid use, the reasons for persistent opioid use and perioperative prescribing of opioids deserve further study.

Figures

Figure 1

Plot of predicted probability of opioid use at 6 months from daily opioid dose (OME) values prior to surgery. A logistic regression model predicting opioid use from daily opioid dose in oral morphine equivalent (OME) values prior to surgery was conducted. A 1-unit increase in OME is associated with a 7% increased odds of being on opioids at 6 months. This plot shows the increase in predicted probabilities of opioid use at 6 months by pre-surgical OME. OME values of 50 or greater are associated with predicted probabilities of 60% or greater of being on opioids at 6 months. OME values of 60 or greater are associated with predicted probabilities of 80% or greater of being on opioids at 6 months.