Presurgical opioid use tied to complications after knee replacement

  • Kim SC & al.
  • JAMA Netw Open
  • 03.07.2019

  • von Kelli Whitlock Burton
  • Clinical Essentials
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Takeaway

  • Patients with a history of continuous opioid use in the year prior to total knee replacement (TKR) had significantly higher risks of revision surgery, vertebral fractures, and opioid overdose within 30 days of surgery compared with patients with intermittent or no opioid use.

Why this matters

  • Nearly 60% of patients reported using opioids at least once in the year before their knee surgery and nearly 8% were continual users, defined as having received prescription opioids at least once every month for a year before surgery.

Study design

  • Cohort study of Medicare enrollees (mean age, 73.9 years) with osteoarthritis who underwent TKR.
  • Funding: NIH and National Institute of Arthritis and Musculoskeletal and Skin Diseases.

Key results

  • Based on opioid dispensing, there were:
    • 7.2% continuous users (≥1 dispensing in each of 12 30-day blocks prior to TKR);
    • 51.0% intermittent users (any dispensing of opioids but not continuous use); 
    • 41.7% opioid-naive patients (no opioids dispensed in the past 12 months).
  • 30 days post-TKR, continuous opioid users reported greater risks for:
    • revision operations (aHR, 1.63; 95% CI, 1.15-2.32);
    • opioid overdose (aHR, 4.82; 95% CI, 1.36-17.07);
    • vertebral fractures (aHR, 2.37; 95% CI, 1.37-4.09).

Limitations

  • This observational study is subject to residual confounding.

Coauthored with Chitra Ravi, MPharm