Preoperative Opioid Use Is Associated with Higher Readmission and Revision Rates in Total Knee and Total Hip Arthroplasty

• Published in: Journal of bone and joint surgery. American volume Vol. 100; no. 14; pp. 1171 - 1176
• Main Authors: Weick, Jack, Bawa, Harpreet, Dirschl, Douglas R., Luu, Hue H.
• Format: Journal Article
• Language: English
• Published: United States The Journal of Bone and Joint Surgery, Inc 18-07-2018
• ISSN: 0021-9355; 1535-1386
• DOI: 10.2106/JBJS.17.01414

Prescription opioid use is epidemic in the U.S. Recently, an association was demonstrated between preoperative opioid use and increased health-care utilization following abdominal surgeries. Given that primary total knee arthroplasty (TKA) and total hip arthroplasty (THA) are 2 of the most common surgical procedures in the U.S., we examined the association of preoperative opioid use with 30-day readmission and early revision rates.
We reviewed 2003 to 2014 data from 2 Truven Health MarketScan databases (commercial insurance and Medicare plus commercial supplemental insurance). Subjects were included if they had a Current Procedural Terminology (CPT) code for primary TKA or THA and were continuously enrolled in the database for at least 6 months prior to the index procedure. Preoperative opioid prescriptions were identified using National Drug Codes (NDCs). Rates of 30-day readmissions and revision arthroplasty were identified and compared among patients with stratified durations of preoperative opioid use in the 6 months preceding TKA or THA.
The study included 324,154 patients in the 1-year follow-up group and 159,822 patients in the 3-year follow-up group. Opioid-naive TKA patients had a lower revision rate than did those with >60 days of preoperative opioid use (1-year cohort: 1.07% compared with 2.14%, p < 0.001; 3-year cohort: 2.58% compared with 5.00%, p < 0.001). A similar trend was noted among THA patients (1-year: 0.38% compared with 1.10%, p < 0.001; 3-year: 1.24% compared with 2.99%, p < 0.001). These trends persisted after adjusting for age, sex, and Charlson Comorbidity Index (CCI). The 30-day readmission rate after TKA or THA was significantly lower for patients with no preoperative opioid use compared with those with >60 days of preoperative opioid use (TKA: 4.82% compared with 6.17%, p < 0.001; THA: 3.71% compared with 5.85%, p < 0.001). Again, this association persisted after adjusting for age, sex, and CCI.
Preoperative opioid use was associated with significantly increased risk of early revision and significantly increased risk of 30-day readmission after TKA and THA. This study illustrates the increased risk of poor outcomes and increased postoperative health-care utilization for patients with long-term opioid use prior to THA and TKA.
Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.