Chronic Use of Opioids Before and After Total Knee Arthroplasty: A Retrospective Cohort Study.
Opioids are commonly used for the management of preoperative and postoperative pain among patients undergoing total knee arthroplasty (TKA). There is limited literature on the chronic use of opioids pre-TKA and post-TKA. The aim of this study was to characterize the use of opioids in TKA patients before and after surgery and identify risk factors of chronic opioid use.



Opioid use among 15,020 patients undergoing TKA (01/01/2001-31/12/2012) was examined. Generalized estimating equations assessed change in total oral morphine equivalents pre-TKA and post-TKA, and logistic regression estimated risk factors of chronic opioid use.



Of the total sample, 7782 (52.0%) patients had at least 1 opioid (38.6% pre-TKA and 34.4% post-TKA). The most commonly prescribed opioids were oxycodone, codeine + acetaminophen, and tramadol. Pre-TKA, 720 (4.8%) patients were chronic opioid users, of which 241 (33.5%) stopped being chronic users after surgery and 479 (66.5%) continued but had a 16% reduction (incidence rate ratio = 0.84; 95% confidence interval, 0.78-0.90) in total oral morphine equivalents. Of the 5077 (33.8%) occasional opioid user pre-TKA, 2407 (47.4%) stopped after surgery. Compared to nonopioid users, chronic users were younger, were female, had more comorbidity, and had longer hospital stays. Older age was associated with ceasing chronic opioid use post-TKA.



There was a reduction in opioid use following TKA. Almost 50% of occasional users and more than 30% of chronic users pre-TKA ceased opioids postoperatively. There was a reduction in use for those chronic users who continued to take opioids postsurgery.
South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.
Craig A
CA
Hansen
Medicine and Devices Surveillance Centre of Research Excellence, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia.
Maria C S
MCS
Inacio
Medicine and Devices Surveillance Centre of Research Excellence, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia.
Nicole L
NL
Pratt
Medicine and Devices Surveillance Centre of Research Excellence, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia.
Elizabeth E
EE
Roughead
Australian Orthopaedic Association National Total Joint Replacement Registry, University of Adelaide, Adelaide, South Australia, Australia.
Stephen E
SE
Graves
D000082:Acetaminophen; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D018771:Arthralgia / Q000188:drug therapy / Q000209:etiology / Q000601:surgery; D019645:Arthroplasty, Replacement, Knee; D003061:Codeine; D004338:Drug Combinations; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000627:therapeutic use; D020370:Osteoarthritis, Knee / Q000150:complications / Q000601:surgery; D010098:Oxycodone; D010149:Postoperative Pain / Q000188:drug therapy; D011184:Postoperative Period; D012189:Retrospective Studies; D012307:Risk Factors
D000701:Analgesics, Opioid; D004338:Drug Combinations; C526278:acetaminophen, codeine drug combination; D000082:Acetaminophen; D009020:Morphine; D010098:Oxycodone; D003061:Codeine
chronic opioid use; opioids; pain; risk factors; total knee arthroplasty