Opioid use and patient outcomes in an Australian hip and knee arthroplasty cohort
Publication Details
Huang, P.,
Brownrigg, J.,
Roe, J.,
Carmody, D.,
Pinczewski, L.,
Gooden, B.,
Lyons, M.,
Salmon, L.,
Martina, K.,
Crighton, J.,
&
O'Sullivan, M.
(2022).
Opioid use and patient outcomes in an Australian hip and knee arthroplasty cohort.
ANZ Journal of Surgery, Early View (Online First).
Abstract
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 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 (
Keywords
arthroplasty, hip, knee, opioids, pain control
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