Increased length of stay, opioid use seen after THA in patients with fibromyalgia
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GRAPEVINE, Texas — Postoperative total hip arthroplasty care in patients with fibromyalgia can be complicated and involve a significantly increased length of stay, results presented here showed.
Furthermore, patients with fibromyalgia had increased odds for hip dislocation and ED visits after THA vs. patients without fibromyalgia, according to findings Mark E. Mildren, MD, presented at the American Association of Hip and Knee Surgeons Annual Meeting.
“Patients with fibromyalgia can have significant musculoskeletal ramifications from undergoing primary total hip arthroplasty. They’re more likely to experience increased length of stay, increased opioid use, increased risk of ER visits and increased risk of dislocation,” Mildren said.
Mildren and colleagues conducted a retrospective review, searching a database for ICD-10 codes for primary THA procedures performed between 2015 and 2020. They found 28,138 patients who underwent THA during the study period, among which 1,455 patients had a diagnosis of fibromyalgia. Researchers collected patient demographics and health care utilization trends, including age, sex, preoperative opioid use, dislocation and ER visits. They used an independent t-test to analyze and compare patients with and those without fibromyalgia for length of stay and ongoing opioid use rates, according to the abstract.
In addition, researchers analyzed the association of fibromyalgia with and odds for dislocation or an ER visit after adjusting for demographic characteristics of the patients.
“We also looked at those patients who were at risk for doing multiple ED visits, defined as whether greater than five visits were involved in the following calendar year,” Mildren said.
“Patients with fibromyalgia tended to be more female, 9:1 (91%). They tended to be younger, with a mean age of 63 [years], and they tended to use more opioids at 31% compared to 19% for patients without fibromyalgia,” he said.
Results showed a longer length of stay in patients with fibromyalgia at 8.44 days (± 8.12 days) vs. 2.65 days (± 3.01 days), which was a statistically significant difference, according to the abstract.
Patients with fibromyalgia had “increased use of opioids at 90 days, increased use of opioids 1 year [and increased] presentations at the ED. They were more likely to become a ‘frequent flyer’ and were more likely to undergo a postop hip dislocation, which wasn’t surprising,” Mildren said.
“From a financial standpoint, these patients use more resources after a total hip. These patients may also have significant impact on your bundled payment models. And future investigations are needed to see what interventions are going to be beneficial for these patients so they don’t utilize, at an increased rate, health care resources after surgery,” he said.
Collapse
Kagan RP, et al. Paper 33. Presented at: American Association of Hip and Knee Surgeons Annual Meeting; Nov. 3-6, 2022; Grapevine, Texas.
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