American College of Rheumatology Annual Meeting

American College of Rheumatology Annual Meeting

Issue: December 2018
November 21, 2018
2 min read

Opioid Use Common Before Total Joint Replacement Surgery

Issue: December 2018
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CHICAGO — More than 60% of older patients with moderate-to-severe hip or knee arthritis used opioids before undergoing total joint replacement surgery, according to recent data.

Of these patients, more than 12% used opioids at least once a month for 1 year. Seoyoung C. Kim, MD, ScD, MSCE, associate professor of medicine at Brigham and Women’s Hospital and Harvard Medical School, said such frequent opioid use could affect the clinical outcomes of surgery.

“There is some evidence showing poorer outcomes if patients use opioids substantially before surgery,” she told Healio Rheumatology. “In addition, patients who use opioids before surgery may be more likely to have opioid dependence or abuse after surgery.”

For their study, Kim and colleagues analyzed Medicare data to determine preoperative opioid use patterns among patients aged 65 years and older who underwent incident total hip replacement (THR) or total knee replacement (TKR) between 2010 and 2014. Participants were defined as continuous opioid users if they had one or more opioids dispensed every month for 1 year before surgery. The researchers assessed average morphine milligram equivalent (MME) per day and the proportion of days covered (PDC) each month. They then compared information on demographics, comorbidity medication use and health care utilization among continuous opioid users and opioid-naive users to identify risk factors for opioid use.

Of the 473,781 participants in included in the analysis, 67.4% were women, 91.5% were white, 155,516 underwent THR and 318,265 underwent TKR. Back pain was common, occurring among 62% of participants who underwent THR and 46.8% who underwent TKR.

The year before surgery, 60.2% of participants used opioids at any time and 12.4% used opioids at least once a month, mostly hydrocodone, tramadol or oxycodone. Approximately 8% of continuous users had used opioids almost every day the year before surgery.

Both MME and PDC increased with time up to the date of surgery. In the month prior to total joint replacement surgery, continuous opioid users had a PDC of more than 90% and used higher MME doses per day. In the THR group, the average MME was 58 mg (equivalent to 58 mg hydrocodone a day) among continuous users vs. 16 mg among any users. In the TKR group, the average MME was 51 mg among continuous users vs. 12 mg among any users.

After adjusting for all covariates, the history of drug abuse (OR = 5.19; 95% CI, 3.96-6.84) and back pain (OR = 2.32; 95% CI, 2.24-2.40) were significantly associated with continuous opioid use. In addition, black patients were twice as likely to continuously use opioids compared with white patients (OR = 2.14; 95% CI, 2.01-2.28).

“This information might be helpful for clinicians to better understand what kind of patients are more likely to use opioids,” Kim said.

The next phase of research will be to examine postoperative opioid use, she added.

“We are currently looking at patterns of post-surgery opioid use, as well as the association between the use of opioids before and after the surgery and the clinical outcomes after surgery,” Kim said. – by Stephanie Viguers


Jin Y, et al. Abstract 1154. Presented at: ACR/ARHP Annual Meeting, Oct. 20-24, 2018; Chicago.

Disclosure: The study was supported by the NIH’s National Institute of Arthritis and Musculoskeletal and Skin Diseases.