Preoperative Chronic Opioid Use and Its Effects on Total Knee Arthroplasty Outcomes

Kelvin Kim; Kevin Chen; Afshin A. Anoushiravani; Mackenzie Roof; William J. Long; Ran Schwarzkopf

doi:10.1055/s-0039-1678538

The Journal of Knee Surgery, Table of Contents

J Knee Surg 2020; 33(03): 306-313
DOI: 10.1055/s-0039-1678538

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Preoperative Chronic Opioid Use and Its Effects on Total Knee Arthroplasty Outcomes

Authors

Kelvin Kim

¹Department of Orthopaedic Surgery, NYU Langone Medical Center, Langone Orthopedic Hospital, New York, New York
Kevin Chen

¹Department of Orthopaedic Surgery, NYU Langone Medical Center, Langone Orthopedic Hospital, New York, New York
Afshin A. Anoushiravani

²Department of Orthopaedic Surgery, Albany Medical Center, Albany, New York
Mackenzie Roof

¹Department of Orthopaedic Surgery, NYU Langone Medical Center, Langone Orthopedic Hospital, New York, New York
William J. Long

¹Department of Orthopaedic Surgery, NYU Langone Medical Center, Langone Orthopedic Hospital, New York, New York
Ran Schwarzkopf

¹Department of Orthopaedic Surgery, NYU Langone Medical Center, Langone Orthopedic Hospital, New York, New York

Abstract

Unsafe opioid distribution remains a major concern among the total knee arthroplasty (TKA) population. Perioperative opioid use has been shown to be associated with poorer outcomes in patients undergoing TKA including longer length of stay (LOS) and discharges to extended care facilities. The current study aims to detail perioperative opioid use patterns and investigate the effects of preoperative chronic opioid use on perioperative quality outcomes in TKA patients. A retrospective analysis was performed on 338 consecutive TKAs conducted at our institution. Two cohorts were compared in this study—preoperative chronic opioid users and nonchronic opioid users. Opioid usage patterns and quality metrics were collected and analyzed over a 3-month preoperative and a 6-month postoperative period. Fifty-four (16.0%) preoperative chronic opioid users were identified out of the total 338 patients included in the study. Preoperative chronic opioid users experienced significantly longer LOS (2.9 vs 2.6 days; p = 0.026). Patients who remained persistent chronic users throughout the preoperative and postoperative stages demonstrated a significantly longer LOS (3.4 days vs 2.5 days; p = 0.017) compared with those who were no longer chronically using opioids by the 6 months postoperative period. By the 6 months postoperative time point, preoperative chronic users were consuming eight times the morphine-equivalents (mg/day) compared with nonchronic users (p < 0.001). Preoperative chronic opioid use was associated with substantially higher usage patterns throughout the postoperative stages. Such opioid use patterns were associated with longer LOS. Given that perioperative chronic opioid use has shown to negatively impact TKA outcomes, future studies refining current perioperative management strategies are warranted. This is a Level II, prognostic study.

Keywords

total knee arthroplasty - chronic opioid - value-based care - quality outcomes

Full Text

References

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