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
