Abstract
Objective: To examine patterns of prescription opioid use before total joint replacement (TJR) and factors associated with continuous use of opioids before TJR. Design: We conducted an observational cohort study among Medicare enrollees aged ≥65 years who underwent TJR between 2010 and 2014. Preoperative opioid use was defined as having any opioid prescription in the 12-month period before TJR. Patients who had an opioid prescription every month for a 12-month period were defined as continuous users. We examined patients’ demographics, pain-related conditions, medication use, other comorbidities, healthcare utilization and their association with use of opioids before TJR. Results: A total of 473,781 patients underwent TJR:,155,516 THR and 318,265 TKR. Among the total cohort, 60.2% patients had any use of opioids and of those, 12.4% used opioids at least once a month continuously over the 12-month baseline period. Correlates of continuous opioid use included African American race (OR = 2.14, 95% confidence intervals (CI) = 2.01–2.28, compared to White patients), history of drug abuse (OR = 5.18, 95% CI = 3.95–6.79) and back pain (OR = 2.32, 95% CI = 2.24–2.39). Conclusions: In this large cohort of patients undergoing TJR, over 60% ever used opioids and 12.4% of them continuously used opioids in the 12-month prior to surgery. Utilization of opioids became more frequent and high-dosed near the surgery. History of drug abuse, back pain, and African American race were strongly associated with continuous use of opioids preoperatively. Further research is needed to determine short-term and long-term risks of preoperative use of opioids in TJR patients and to optimize pre- and post-TJR pain management of patients with arthritis.
Original language | English (US) |
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Pages (from-to) | 1445-1453 |
Number of pages | 9 |
Journal | Osteoarthritis and Cartilage |
Volume | 27 |
Issue number | 10 |
DOIs | |
State | Published - Oct 2019 |
Funding
The authors do not have competing interests. YCL received a research grant from Pfizer and stock in Express Scripts . SCK received research grants to Brigham and Women's Hospital from Pfizer , Roche and Bristol-Myers Squibb for unrelated studies. The authors do not have competing interests. YCL received a research grant from Pfizer and stock in Express Scripts. SCK received research grants to Brigham and Women's Hospital from Pfizer, Roche and Bristol-Myers Squibb for unrelated studies.This study was supported by grants from the National Institutes of Health/National Institute of Arthritis and Musculoskeletal and Skin Diseases (Grant Number: 1R01AR069557-01A1). This study was supported by grants from the National Institutes of Health/ National Institute of Arthritis and Musculoskeletal and Skin Diseases (Grant Number: 1R01AR069557-01A1 ).
Keywords
- Opioids
- Osteoarthritis
- Total joint replacement
ASJC Scopus subject areas
- Rheumatology
- Biomedical Engineering
- Orthopedics and Sports Medicine