In a large cohort of Medicare beneficiaries undergoing total knee or hip replacement, preoperative opioid use was reported in approximately 60% of patients, including 12.4% who had used opioids continuously for 12 consecutive months prior to the surgery, according to study results published in Osteoarthritis and Cartilage.
Previous studies have reported a high prevalence of opioid use for the preoperative pain management of arthritis. The goal of this study was to characterize the patterns of opioids use during the 12 months before total knee or hip replacement surgery.
This observational cohort study used Medicare claim data of patients age ≥65 years who underwent total knee or hip replacement surgery between 2010 and 2014. Preoperative opioid use was defined as having any opioid prescription in the 12 months before surgery. Continuous users were patients who had any opioid prescription in every month for 12-months before surgery.
A total of 473,781 patients who underwent knee or hip replacement between 2010 and 2014 were identified. Of these, 155,516 patients had total hip replacement (mean age, 75.2±6.6 years) and 318,265 had total knee replacement surgery (mean age, 73.9±5.8 years).
A total of 60.5% patients in this cohort had any opioid prescription in the 12 months preceding the surgery; 64.3% of patients who had total hip replacement and 58.2% of patients who had knee replacement surgery. Continuous opioid use was reported in 8% and 7.2% of patients who had total hip and knee replacement surgery, respectively. Opioid use was found to have increased frequency and dosing as the surgery approached.
Several risk factors for continuous opioid use, including race/ethnicity, geographic location, pain-related conditions, and history of drug abuse were identified with a multivariable logistic regression model. The risk for continuous use was found to be greater in African-American vs white patients (odds ratio, 2.14; 95% CI, 2.01-2.28) and in patients residing in the West and South vs the Northeast. A history of drug abuse was strongly associated with an increased risk for continuous opioid use (odds ratio, 5.18; 95% CI, 3.95-6.79). Patients with vs without back pain had more than 2-fold increased risk for continuous opioid use (odds ratio, 2.32; 95% CI, 2.24-2.39).
Study limitations include the observational nature of the study, the lack of direct assessment of the severity of disease or pain, and the inability to verify whether the patients consumed opioids as prescribed.
“Further efforts are needed to carefully determine risks and benefits of opioids for patients based on their individual characteristics before and after [total joint replacement] and to minimize the adverse outcomes due to the chronic preoperative opioid use,” concluded the researchers.
Jin Y, Solomon DH, Franklin PD, et al. Patterns of prescription opioid use before total hip and knee replacement among US Medicare enrollees (published online June 26, 2019). Osteoarthritis Cartilage. doi:10.1016/j.joca.2019.05.023