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Patients on multiple opiates prior to TKA, THA filled more opiate prescriptions after surgery
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Recently published results showed more opiate prescriptions were filled postoperatively among patients who took multiple opiates or more potent opiates prior to total joint arthroplasty.
Researchers used the Michigan Automated Prescription System database, hospital charts and office-based charts to retrospectively review data for opiate-containing medications during the 3-month period before surgery and for the first 12 months after surgery for 367 patients who underwent primary total knee arthroplasty (TKA) or total hip arthroplasty (THA). Researchers recorded the number of prescriptions filled per 6-week period from 0 months to 3 months before surgery, 0 weeks to 6 weeks after surgery, 7 weeks to 12 weeks after surgery, 3 months to 6 months after surgery and 6 months to 12 months after surgery. Patients with two or more opiate prescriptions filled per 6-week period in the 3 months before surgery were defined by researchers as chronic opiate users, and the control group included patients who did not meet this requirement.
Overall, researchers analyzed 315 patients with procedures that occurred between October 2010 and November 2011. Of these, 158 patients (68% were women) underwent primary TKA and 157 patients (64% were women) underwent primary THA.
Results showed the average prescriptions filled in the 6 weeks immediately after surgery significantly increased for all groups. While all groups had a decrease in opioid use with time, researchers found a slower rate of decrease among chronic opiate users. According to results, 64% of patients who were chronic opiate users were still filling opiate prescriptions at 1 year postoperatively vs. 22% of patients in the control group. Significantly more opiate prescriptions were filled 1 year postoperatively by patients who used oxycodone, morphine or transdermal fentanyl, results showed. Researchers also noted patients who were chronic opiate users filled three-times more prescriptions, on average, 1 year after their arthroplasty.
Compared with 21% of patients in the control group, results showed 31% of patients who were chronic opiate users were discharged to an extended care facility. Researchers found 77% of all opiate prescriptions were written by a practitioner other than the surgeon. – by Casey Tingle
Disclosures: Zarling reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.
Perspective
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William G. Hamilton, MD
This study offers interesting insight into a problem all total joint surgeons have managed: opioid use in the total joint patient. While opioids are an important part of the management of perioperative pain, it is well accepted that preoperative opioid use can worsen the patient’s clinical course. This study helps to illuminate that point.
While the study does have a relatively small sample size and is isolated to patients from one practice in the state of Michigan, the messages likely apply nationwide. In fact, today’s situation may be worse than depicted in this study, as the article queried data from 2010 to 2011, and it is well documented that this problem has grown significantly in recent years.
The main message of the paper is that patients using opioids prior to the joint replacement are more likely to be using these medications up to a year after surgery. Sixty-four percent of chronic opioid users preoperatively were still using opioids up to 1 year postoperatively. Based on the figures supplied, it does appear that total hip arthroplasty is more effective than total knee arthroplasty at eliminating chronic opioid use.
I was surprised that 22% of patients who were not classified as preoperative chronic opioid users were still receiving these prescriptions 1 year after surgery. I think this highlights how important perioperative opioid management and oversight has become, because at least a small percentage of our patients use more opioids well after their recovery has completed. Only 23% of the total opioid prescriptions were written by the orthopedic surgeons, highlighting how important collaboration and communication across specialties has become.
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