Opioid use and patient outcomes in an Australian hip and knee arthroplasty cohort.
arthroplasty
hip
knee
opioids
pain control
Journal
ANZ journal of surgery
ISSN: 1445-2197
Titre abrégé: ANZ J Surg
Pays: Australia
ID NLM: 101086634
Informations de publication
Date de publication:
09 2022
09 2022
Historique:
received:
30
06
2022
accepted:
26
07
2022
entrez:
13
9
2022
pubmed:
14
9
2022
medline:
15
9
2022
Statut:
ppublish
Résumé
To determine the prevalence of opioid use in Australian hip (THA) or knee (TKA) cohort, and its association with outcomes. About 837 primary THA or TKA subjects prospectively completed Oxford Scores, and Knee or Hip Osteoarthritis Outcomes Score(KOOS/HOOS) and opioid use in the previous week before arthroplasty. Subjects repeated the baseline survey at 6 months, with additional questions regarding satisfaction. Opioid use was reported by 19% preoperatively and 7% at 6 months. Opioid use was 46% at 6 weeks and 10% at 6 months after TKR, and 16% at 6 weeks and 4% at 6 months after THR. Preoperative opioid use was associated with back pain(OR 2.2, P = 0.006), anxiety or depression(OR 1.8, P = 0.001) and Oxford knee scores <30(OR 5.6, P = 0.021) in TKA subjects, and females in THA subjects(OR 1.7, P = 0.04). There was no difference between preoperative opioid users and non-users for satisfaction, or KOOS or HOOS scores at 6 months. 77% of patients taking opioids before surgery had ceased by 6 months, and 3% of preoperative non users reported opioid use at 6 months. Opioid use at 6 months was associated with preoperative use (OR 6.6-14.7, P < 0.001), and lower 6 month oxford scores (OR 4.4-83.6, P < 0.01). One in five used opioids before arthroplasty. Pre-operative opioid use was the strongest risk factor for opioid use at 6 months, increasing odds 7-15 times. Prolonged opioid use was rarely observed in the opioid naïve (<5% TKA and 1% THA). Preoperative opioid use was not associated with inferior outcomes or satisfaction.
Sections du résumé
BACKGROUND
To determine the prevalence of opioid use in Australian hip (THA) or knee (TKA) cohort, and its association with outcomes.
METHODS
About 837 primary THA or TKA subjects prospectively completed Oxford Scores, and Knee or Hip Osteoarthritis Outcomes Score(KOOS/HOOS) and opioid use in the previous week before arthroplasty. Subjects repeated the baseline survey at 6 months, with additional questions regarding satisfaction.
RESULTS
Opioid use was reported by 19% preoperatively and 7% at 6 months. Opioid use was 46% at 6 weeks and 10% at 6 months after TKR, and 16% at 6 weeks and 4% at 6 months after THR. Preoperative opioid use was associated with back pain(OR 2.2, P = 0.006), anxiety or depression(OR 1.8, P = 0.001) and Oxford knee scores <30(OR 5.6, P = 0.021) in TKA subjects, and females in THA subjects(OR 1.7, P = 0.04). There was no difference between preoperative opioid users and non-users for satisfaction, or KOOS or HOOS scores at 6 months. 77% of patients taking opioids before surgery had ceased by 6 months, and 3% of preoperative non users reported opioid use at 6 months. Opioid use at 6 months was associated with preoperative use (OR 6.6-14.7, P < 0.001), and lower 6 month oxford scores (OR 4.4-83.6, P < 0.01).
CONCLUSION
One in five used opioids before arthroplasty. Pre-operative opioid use was the strongest risk factor for opioid use at 6 months, increasing odds 7-15 times. Prolonged opioid use was rarely observed in the opioid naïve (<5% TKA and 1% THA). Preoperative opioid use was not associated with inferior outcomes or satisfaction.
Identifiants
pubmed: 36097420
doi: 10.1111/ans.17969
pmc: PMC9543592
doi:
Substances chimiques
Analgesics, Opioid
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2261-2268Subventions
Organisme : Friends of The Mater Foundation
Informations de copyright
© 2022 The Authors. ANZ Journal of Surgery published by John Wiley & Sons Australia, Ltd on behalf of Royal Australasian College of Surgeons.
Références
Anesth Analg. 2019 Aug;129(2):553-566
pubmed: 30768461
Eur J Pain. 2018 Apr 20;:
pubmed: 29676839
Clin Orthop Relat Res. 2018 Dec;476(12):2432-2441
pubmed: 30179951
Curr Rheumatol Rep. 2020 Aug 17;22(10):58
pubmed: 32808102
J Bone Joint Surg Br. 1996 Mar;78(2):185-90
pubmed: 8666621
J Am Acad Orthop Surg. 2020 Apr 1;28(7):301-307
pubmed: 31977344
J Arthroplasty. 2018 Aug;33(8):2449-2454
pubmed: 29753617
BMC Musculoskelet Disord. 2019 May 18;20(1):234
pubmed: 31103029
J Arthroplasty. 2018 Jan;33(1):113-118
pubmed: 28887020
J Bone Joint Surg Am. 2017 May 17;99(10):803-808
pubmed: 28509820
Drug Alcohol Depend. 2021 Jan 1;218:108350
pubmed: 33121867
Pain. 2016 Mar;157(3):643-651
pubmed: 26588693
J Biomed Inform. 2009 Apr;42(2):377-81
pubmed: 18929686
BMJ Open. 2016 Apr 29;6(4):e010664
pubmed: 27130165
Lancet. 2018 Nov 10;392(10159):1736-1788
pubmed: 30496103
Osteoarthritis Cartilage. 2019 Nov;27(11):1578-1589
pubmed: 31278997
N Z Med J. 2019 Dec 13;132(1507):33-47
pubmed: 31830015
Osteoarthritis Cartilage. 2019 Oct;27(10):1445-1453
pubmed: 31251985
BMC Musculoskelet Disord. 2019 Sep 14;20(1):427
pubmed: 31521139
J Arthroplasty. 2017 Sep;32(9):2658-2662
pubmed: 28478186
J Bone Joint Surg Br. 1998 Jan;80(1):63-9
pubmed: 9460955
Ann Med. 2001 Jul;33(5):337-43
pubmed: 11491192
JAMA. 2018 Dec 18;320(23):2448-2460
pubmed: 30561481
Anesth Analg. 2019 Aug;129(2):543-552
pubmed: 30897590
Clin Orthop Relat Res. 2015 Jul;473(7):2402-12
pubmed: 25694266
J Arthroplasty. 2017 Mar;32(3):811-817.e1
pubmed: 27836577
Clin Orthop Relat Res. 2016 Jun;474(6):1461-71
pubmed: 26926773
J Arthroplasty. 2016 Sep;31(9 Suppl):282-7
pubmed: 27105557
BMC Musculoskelet Disord. 2020 Jun 22;21(1):398
pubmed: 32571280
J Bone Joint Surg Am. 2011 Nov 2;93(21):1988-93
pubmed: 22048093
J Arthroplasty. 2020 Nov;35(11):3099-3107.e14
pubmed: 32684397