Does Preoperative Opioid Use Increase the Risk of Early Revision Total Hip Arthroplasty?

Nicholas A Bedard; David E DeMik; S Blake Dowdle; Jessell M Owens; Steve S Liu; John J Callaghan

doi:10.1016/j.arth.2018.01.018

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Does Preoperative Opioid Use Increase the Risk of Early Revision Total Hip Arthroplasty?

Journal article

Peer reviewed

Does Preoperative Opioid Use Increase the Risk of Early Revision Total Hip Arthroplasty?

Nicholas A Bedard, David E DeMik, S Blake Dowdle, Jessell M Owens, Steve S Liu and John J Callaghan

The Journal of arthroplasty, Vol.33(7S), pp.S154-S156

07/2018

DOI: 10.1016/j.arth.2018.01.018

PMID: 29452972

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Abstract

The purpose of this study is to evaluate the impact of preoperative opioid use on the risk of subsequent revison after primary total hip arthroplasty (THA). The Humana database was queried for unilateral THA between 2007-2015. Patients were tracked for the occurrence of an ipsilateral revision THA for 2 years. Factors analyzed included preoperative opioid use (defined as a history of opioid prescription filled within 3 months preceding primary THA), age, sex, diabetes, anxiety/depression, chronic kidney disease, and obesity (body mass index > 30 kg/m ). Multivariate logistic regression analysis was used to determine odds ratios. A total of 17,695 primary THA patients were analyzed and 0.88% (n = 155) underwent revision THA within 2 years. Preoperative opioid use occurred in 36.7% of all. Females comprised 58.7% of the total cohort and 80% were >50 years. Preoperative opioid users were significantly more likely to undergo early THA revision (1.2% vs 0.7%, P < .001). Other patient factors that significantly increased the risk of early THA revision included obesity (1.3% vs 0.8%, P = .03) and a preoperative diagnosis of anxiety/depression (1.9% vs 0.8%, P = .006). Opioid use within 3 months preceding THA independently predicts an increased risk of early revision. Additionally, independent predictors of early revision include obesity and a diagnosis of anxiety/depression. Factors such as these will need to be considered in risk adjustment models when assessing quality of care or implementing bundled payment initiatives. Further research is needed to evaluate whether discontinuing opioids before surgery mitigates this risk.

Body Mass Index

Multivariate Analysis

Opioid-Related Disorders - etiology

Humans

Middle Aged

Risk Factors

Analgesics, Opioid - therapeutic use

Male

Arthroplasty, Replacement, Hip - adverse effects

Analgesics, Opioid - adverse effects

Female

Obesity - etiology

Reoperation - adverse effects

Aged

Odds Ratio

Cohort Studies

Databases, Factual

Preoperative Period

Details

Title: Subtitle: Does Preoperative Opioid Use Increase the Risk of Early Revision Total Hip Arthroplasty?
Creators: Nicholas A Bedard - Department of Orthopaedics, University of Iowa, Iowa City, IA
David E DeMik - Department of Orthopaedics, University of Iowa, Iowa City, IA
S Blake Dowdle - Department of Orthopaedics, University of Iowa, Iowa City, IA
Jessell M Owens - Department of Orthopaedics, University of Iowa, Iowa City, IA
Steve S Liu - Department of Orthopaedics, University of Iowa, Iowa City, IA
John J Callaghan - Department of Orthopaedics, University of Iowa, Iowa City, IA
Resource Type: Journal article
Publication Details: The Journal of arthroplasty, Vol.33(7S), pp.S154-S156
Publisher: United States
DOI: 10.1016/j.arth.2018.01.018
PMID: 29452972
ISSN: 0883-5403
eISSN: 1532-8406
Language: English
Date published: 07/2018
Academic Unit: Roy J. Carver Department of Biomedical Engineering; Orthopedics and Rehabilitation
Record Identifier: 9984040384002771

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