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Preoperative opioid use increased risk of opioid use following TKA

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Preoperative opioid use increased risk of opioid use following TKA
Orthopedics Today, July 2016

Patients who were prescribed opioids prior to total knee arthroplasty had an increased risk of opioid use 12 months following the procedure, according to results presented at the Current Concepts in Joint Replacement Spring Meeting.

“Preoperative opioid use was most predictive of increased refills of opioids following total knee arthroplasty,” John J. Callaghan, MD, of the University of Iowa Hospitals and Clinics, said in his presentation. “However, other intrinsic patient characteristics were also predictive of long-term opioid use and I think we have to address those in order to address the opioid problem, too.”

Opioid use in the United States
Among patients who underwent total knee arthroplasty (TKA), Callaghan identified the rates of opioid use prior to TKA, evaluated postoperative trends of opioid use the year following TKA and identified risk factors for prolonged opioid use post-TKA.

Preoperative opioid use was defined as opioid prescriptions filled within 3 months prior to surgery, while non-opioid use was defined as patients who never had an opioid prescription filled. Researchers also evaluated opioid refill rates and differences in opioid prescription refill rates between opioid users and non-opioid users.

Within 3 months prior to TKA, results showed 31% of TKA patients were prescribed opioids, a figure that increased more than 9% during the study period.

“Postoperatively, opioid use was high in the beginning even for non-opioid users, but their use was less than the opioid users and the trends came down over 3 months and you can see the opioid users still have a high use of opioids after the procedure even after 12 months,” Callaghan said.

He noted opioid use was 1.6% higher in the first month after surgery, 4.9% higher by 3 months and approximately 10% higher after 12 months. During the 12 month follow-up, results showed women had between 1.1 times to 1.9 times higher use of opioids vs. men. Patients younger than 50 years had a 1.5% higher rate of opioid use than those 50 years of age or older.

According to Callaghan, patients with anxiety, low back pain, fibromyalgia, drug dependence, alcohol dependence and a history of tobacco use were at a significantly increased risk for opioid use through all monthly intervals. Patients in the opioid group also experienced more medical complications and more 90-day complications, including respiratory failure, acute kidney injury, pneumonia and surgical site infection.

Differences in Europe
While the results of this study were consistent with previously published literature that demonstrated similar rates of preoperative and postoperative opioid use, Callaghan noted results from Europe and other countries showed a lower rate of preoperative opioid use and a lower rate of opioid prescription the year following surgery.

“There was a similar study done in France and only 9% of patients preoperatively were opioid users vs. 31% in our study and only 6% were prescribed opioids at some point in the year afterwards whereas it is 70% in this country, so there must be something we can learn,” Callaghan said.

He added, “One of the things that happened in this country is we became obsessed with patients postoperatively having zero pain. Once we got into that, I think it changed the whole dialogue and the surgeons had to change what they were doing. Some of the states required you to complete a pain management module every year, and I think things like that set us backwards rather than forward.”

by Casey Tingle

Reference:
Callaghan JJ. Paper #50. Presented at: Current Concepts in Joint Replacement Spring Meeting; May 22-25, 2016; Las Vegas.
For more information:
John J. Callaghan, MD, can be reached at the University of Iowa, 200 Hawkins Dr., Iowa City, IA 52242
 

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