title: Risk factors for persistent and new chronic opioid use in patients undergoing total hip arthroplasty: a retrospective cohort study.
abstract: OBJECTIVE
  To determine chronic opioid use pre-THA (total hip arthroplasty) and post-THA, and risk factors for persistent or new chronic opioid use post-THA.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Australian Government Department of Veterans' Affairs health claims database.
  
  
  METHODS
  9525 patients who had an elective unilateral THA between 1/01/2001 and 12/31/2012.
  
  
  METHODS
  Chronic opioid use. Defined as 90 days of continuous opioid use or 120 days of non-continuous use.
  
  
  RESULTS
  Pre-THA, 6.2% (n=593) of patients were chronic users, while 5.2% (n=492) were post-THA. Among the 492 postoperative chronic users, 302 (61%) were chronic users pre-THA and post-THA and 190 (39%) became new chronic users after surgery. Risk factors for persistent chronic use were younger age (OR=0.96, 95% CI 0.93 to 0.99/1-year increment), back pain (OR=1.99, 95% CI 1.20 to 3.23), diabetes (OR=3.52, 95% CI 1.05 to 11.8), hypnotics use (OR=2.52, 95% CI 1.48 to 4.30) and higher pre-THA opioid exposure (compared with opioid use for 94-157 days, 157-224 days (OR=3.75, 95% CI 2.28 to 6.18), 225+ days (OR=5.18, 95% CI 2.92 to 9.19). Risk factors for new chronic opioid use post-THA were being a woman (OR=1.40, 95% CI 1.00 to 1.96), back pain (OR=3.90, 95% CI 2.85 to 5.33), depression (OR=1.70, 95% CI 1.20 to 2.41), gastric acid disease (OR=1.62, 95% CI 1.16 to 2.25), migraine (OR=5.11, 95% CI 1.08 to 24.18), liver disease (OR=4.33, 95% CI 1.08 to 17.35), weight loss (OR=2.60, 95% CI 1.06 to 6.39), dementia (OR=2.19, 95% CI 1.04 to 4.61), hyperlipidaemia (OR=1.38, 95% CI 1.00 to 1.91), hypnotics (OR=1.56, 95% CI 1.13 to 2.16) and antineuropathic pain medication use (OR=3.11, 95% CI 2.05 to 4.72).
  
  
  CONCLUSIONS
  Patients undergoing THA are exposed to opioids for long periods of time, putting them at high risk of harm related to opioid use. We identified groups at risk of chronic opioid use, including younger patients and women, as well as modifiable risk factors of chronic opioid use, including level of opioid exposure presurgery and hypnotic use. These indicators of chronic opioid use can be used by clinicians to target patient groups for suitable pain management interventions.
authors.affiliation: Medicine and Device Surveillance Centre of Research Excellence, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia.
authors.forename: Maria C S
authors.initials: MC
authors.lastname: Inacio
authors.affiliation: Medicine and Devices Surveillance Centre of Research Excellence, School of Pharmacy and Medical Sciences, University of South Australia, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.
authors.forename: Craig
authors.initials: C
authors.lastname: Hansen
authors.affiliation: Medicine and Device Surveillance Centre of Research Excellence, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia.
authors.forename: Nicole L
authors.initials: NL
authors.lastname: Pratt
authors.affiliation: Australian Orthopaedic Association National Total Joint Replacement Registry, University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Graves
authors.affiliation: Medicine and Device Surveillance Centre of Research Excellence, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia.
authors.forename: Elizabeth E
authors.initials: EE
authors.lastname: Roughead
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects; D001315:Australia / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D009293:Opioid-Related Disorders / Q000150:complications* / Q000453:epidemiology; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D011184:Postoperative Period; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014728:Veterans
chemical_list: D000701:Analgesics, Opioid
keywords: chronic; opioids; risk factors; total hip arthroplasty