TY - JOUR
T1 - Association of Preoperative Opioid Use With Mortality and Short-term Safety Outcomes After Total Knee Replacement
AU - Kim, Seoyoung C.
AU - Jin, Yinzhu
AU - Lee, Yvonne C.
AU - Lii, Joyce
AU - Franklin, Patricia D.
AU - Solomon, Daniel H.
AU - Franklin, Jessica M.
AU - Katz, Jeffrey N.
AU - Desai, Rishi J.
N1 - Funding Information:
Administrative, technical, or material support: Kim, P. D. Franklin, Solomon, J. M. Franklin. Supervision: Kim, Solomon, J. M. Franklin. Conflict of Interest Disclosures: Dr Kim reported receiving grants from the US National Institutes of Health (NIH) during the conduct of the study and grants from AbbVie, Bristol-Myers Squibb, Pfizer, and Roche Holding (paid to Brigham and Women’s Hospital) outside the submitted work. Dr Lee reported receiving grants from Pfizer outside the submitted work, owning stock in Cigna-Express Scripts, and serving as an advisory board member for Eli Lilly. Dr P. D. Franklin reported grants from the National Institute of Arthritis and Musculoskeletal and Skin Diseases and the Agency for Healthcare Research and Quality during the conduct of the study and grants from the Patient-Centered Outcomes Research Institute outside the submitted work. Dr J. M. Franklin reported receiving grants from NIH during the conduct of the study. Dr Katz reported receiving grants from NIH during the conduct of the study and grants from Samumed and Flexion Therapeutics outside the submitted work. Dr Desai reported receiving grants from Bayer, Novartis, and Vertex Pharmaceuticals outside the submitted work. No other disclosures were reported.
Funding Information:
Funding/Support: This study was supported by a grant from the National Institutes of Health and National Institute of Arthritis and Musculoskeletal and Skin Diseases (R01AR069557-01A1).
Publisher Copyright:
© 2019 Kim SC et al. JAMA Network Open.
PY - 2019/7/31
Y1 - 2019/7/31
N2 - Importance: Prescription opioid use is common among patients with moderate to severe knee osteoarthritis before undergoing total knee replacement (TKR). Preoperative opioid use may be associated with worse clinical and safety outcomes after TKR. Objective: To determine the association of preoperative opioid use among patients 65 years and older with mortality and other complications at 30 days post-TKR. Design, Setting, And Participants: This cohort study used claims data from January 1, 2010, to December 31, 2014, from a random sample of US Medicare enrollees 65 years and older who underwent TKR. Based on opioid dispensing in 360 days prior to TKR, patients were classified as continuous (≥1 opioid dispensing in each of the past 12 months) or intermittent (any dispensing of opioids in the past 12 months but not continuous use) opioid users or as opioid-naive patients (no opioids dispensed in the past 12 months). Data analyses were conducted from October 3, 2017, to November 8, 2018. Main Outcomes and Measures: Primary outcomes included in-hospital mortality and 30-day post-TKR mortality, hospital readmission, and revision operation. Secondary safety outcomes at 30 days post-TKR included opioid overdose and vertebral and nonvertebral fracture. Multivariable Cox proportional hazards models estimated hazard ratios (HRs) and 95% CIs. Results: Of 316593 patients (mean [SD] age, 73.9 [5.8] years; 214677 [67.8%] women) who underwent TKR, 22895 (7.2%) were continuous opioid users, 161511 (51.0%) were intermittent opioid users, and 132187 (41.7%) were opioid naive. In-hospital mortality occurred in 276 patients (0.09%). At 30 days post-TKR, 828 patients (0.26%) died, 16786 patients (5.30%) had hospital readmission, and 921 patients (0.29%) had a revision operation. All primary and secondary outcomes occurred more frequently among continuous opioid users compared with opioid-naive patients. Compared with opioid-naive patients and after adjusting for demographic characteristics, combined comorbidity score, number of different prescription medications, and frailty, continuous opioid users had greater risk of revision operations (HR, 1.63; 95% CI, 1.15-2.32), vertebral fractures (HR, 2.37; 95% CI, 1.37-4.09), and opioid overdose (HR, 4.82; 95% CI, 1.36-17.07) at 30 days post-TKR. However, after adjusting covariates, there were no statistically significant differences in in-hospital (HR, 1.18; 95% CI, 0.73-1.90) or 30-day (HR, 1.05; 95% CI, 0.73-1.51) mortality between continuous opioid users and opioid-naive patients. Conclusions and Relevance: After adjusting for baseline risk profiles, including comorbidities and frailty, continuous opioid users had a higher risk of revision operations, vertebral fractures, and opioid overdose at 30 days post-TKR but not of in-hospital or 30-day mortality, compared with opioid-naive patients. These results highlight the need for better understanding of patient characteristics associated with chronic opioid use to optimize preoperative assessment of overall risk after TKR..
AB - Importance: Prescription opioid use is common among patients with moderate to severe knee osteoarthritis before undergoing total knee replacement (TKR). Preoperative opioid use may be associated with worse clinical and safety outcomes after TKR. Objective: To determine the association of preoperative opioid use among patients 65 years and older with mortality and other complications at 30 days post-TKR. Design, Setting, And Participants: This cohort study used claims data from January 1, 2010, to December 31, 2014, from a random sample of US Medicare enrollees 65 years and older who underwent TKR. Based on opioid dispensing in 360 days prior to TKR, patients were classified as continuous (≥1 opioid dispensing in each of the past 12 months) or intermittent (any dispensing of opioids in the past 12 months but not continuous use) opioid users or as opioid-naive patients (no opioids dispensed in the past 12 months). Data analyses were conducted from October 3, 2017, to November 8, 2018. Main Outcomes and Measures: Primary outcomes included in-hospital mortality and 30-day post-TKR mortality, hospital readmission, and revision operation. Secondary safety outcomes at 30 days post-TKR included opioid overdose and vertebral and nonvertebral fracture. Multivariable Cox proportional hazards models estimated hazard ratios (HRs) and 95% CIs. Results: Of 316593 patients (mean [SD] age, 73.9 [5.8] years; 214677 [67.8%] women) who underwent TKR, 22895 (7.2%) were continuous opioid users, 161511 (51.0%) were intermittent opioid users, and 132187 (41.7%) were opioid naive. In-hospital mortality occurred in 276 patients (0.09%). At 30 days post-TKR, 828 patients (0.26%) died, 16786 patients (5.30%) had hospital readmission, and 921 patients (0.29%) had a revision operation. All primary and secondary outcomes occurred more frequently among continuous opioid users compared with opioid-naive patients. Compared with opioid-naive patients and after adjusting for demographic characteristics, combined comorbidity score, number of different prescription medications, and frailty, continuous opioid users had greater risk of revision operations (HR, 1.63; 95% CI, 1.15-2.32), vertebral fractures (HR, 2.37; 95% CI, 1.37-4.09), and opioid overdose (HR, 4.82; 95% CI, 1.36-17.07) at 30 days post-TKR. However, after adjusting covariates, there were no statistically significant differences in in-hospital (HR, 1.18; 95% CI, 0.73-1.90) or 30-day (HR, 1.05; 95% CI, 0.73-1.51) mortality between continuous opioid users and opioid-naive patients. Conclusions and Relevance: After adjusting for baseline risk profiles, including comorbidities and frailty, continuous opioid users had a higher risk of revision operations, vertebral fractures, and opioid overdose at 30 days post-TKR but not of in-hospital or 30-day mortality, compared with opioid-naive patients. These results highlight the need for better understanding of patient characteristics associated with chronic opioid use to optimize preoperative assessment of overall risk after TKR..
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U2 - 10.1001/jamanetworkopen.2019.8061
DO - 10.1001/jamanetworkopen.2019.8061
M3 - Article
C2 - 31365106
AN - SCOPUS:85070801513
SN - 2574-3805
VL - 2
JO - JAMA network open
JF - JAMA network open
IS - 7
M1 - e198061
ER -