Patient-reported outcome measure for fatigue may help predict opioid use after THA, TKA
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The fatigue domain of the 29-item Patient-Reported Outcomes Measurement Information System Profile, or PROMIS-29, used before total hip or knee arthroplasty predicted postoperative opioid use, results of a prospective study showed.
Eytan M. Debbi, MD, PhD, said at the American Association of Hip and Knee Surgeons Annual Meeting that although he and his colleagues used other PROMIS-29 domains, as well as the pain catastrophizing scale, to study 243 opioid-naïve patients undergoing THA or TKA for osteoarthritis at Hospital for Special Surgery, only the fatigue domain of PROMIS-29 was significantly associated with postoperative morphine-milligram equivalent (MME) opioid consumption.
“Patients reporting fatigue preoperatively may have greater opioid use postoperatively that can be expected,” Debbi said. “There’s no clear association between pain and between depression and anxiety and pain control and opioid use after surgery. Clinicians may still be prescribing more than necessary. They should take these findings into account when prescribing opioids after surgery,” he said.
To determine MME opioid consumption postoperatively through the time of opioid cessation, patients completed a weekly survey. Researchers then used statistical models to determine whether any associations existed between total MMEs, refilled MMEs, the PROMIS-29 domains and the time to opioid cessation.
Results showed that among THA patients, median MME consumption was 35 in the first 12 weeks postoperatively. Among TKA patients, it was 203. In addition, the median time to opioid cessation was 1 week for THA patients and 3 weeks for TKA patients.
According to the abstract, multivariable regression showed an association between each minimal possible increase in the preoperative PROMIS-29 fatigue T-Score and the postoperative consumption of 12 added total MMEs in the first 12 postoperative weeks.
In addition, results showed minimal possible increases in the preoperative PROMIS-29 fatigue T-Score were each associated with 18 hours later time to cessation, which was a statistically significant association.
“Future studies are needed to further understand the association between fatigue, pain and opioid consumption,” Debbi said.
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Krell EC, et al. Paper 7. Presented at: American Association of Hip and Knee Surgeons Annual Meeting. Nov. 11-14, 2021; Dallas (hybrid meeting).
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