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Opioid use increasing in US patients for pain management prior to TKA
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ORLANDO, Fla. — In the United States, the opioid use epidemic continues to rise among patients undergoing total knee arthroplasty, according to a speaker here.
“The United States is in the midst of an opioid epidemic. Gram for gram, U.S. residents consume more narcotic medication than any other nation worldwide,” John J. Callaghan, MD, said at the Current Concepts in Joint Replacement Winter Meeting. “Appropriate pain management is extremely important, but opioid use is not without individual and societal risks.”
According to Callaghan, the total societal cost of prescription opioid abuse in 2007 was calculated to be around $55 billion.
The World Health Organization reported that U.S. residents consume approximately 99% of the world’s supply of hydrocodone and 83% of the world’s oxycodone.
Drug deaths from opioid use have increased 23% over the last decade.
“Orthopedic surgeons represent the third highest opioid-prescribing specialty within the United States,” Callahan said. “A recent Cochrane review concluded that opioids have minimal effect on pain or function. Any observed effect from opioid use were of questionable clinical relevance, with contrasts in the significant increases in adverse events from these medications, which has been shown in a number of studies on joint replacement patients.”
Due to the rising concern for opioid use, the American Academy of Orthopaedic Surgeons (AAOS) released practice recommendations for combating excessive and inappropriate opioid use.
Callaghan and colleagues conducted a study to identify rates of opioid use prior to primary total knee arthroplasty (TKA), evaluate postoperative trends in opioid use throughout the year following TKA and identify risk factors for prolonged opioid use following TKA.
Among 73,000 study patients, 31% were using opioids prior to TKA and 40% were not using opioids.
Callaghan noted approximately one-third of TKA patients have filled an opioid prescription within 3 months prior to their surgery, which increased over 9% within a 9-year period.
“These findings are consistent with previous studies demonstrating similar rates of preoperative opioid use in the United States and prolonged opioid use requirements among opioid users,” he said. – by Nhu Te
Reference:
Callaghan J. Paper #97. Presented at: Current Concepts in Joint Replacement Winter Meeting; Dec. 14-17; Orlando.
Disclosure: Callaghan reports he is a consultant and receives royalty for intellectual property transfer for hip and knee implant designs; has board membership to the Journal of Arthroplasty, Orthopaedic Research and Education Foundation and the International Hip Society; and receives royalties for editing books from Wolters Kluwer.