Perioperative Chronic Opioid Use and its Effects on Total Knee Arthroplasty Outcomes

Background: Perioperative opioid use has been shown to lead to poorer outcomes in patients undergoing total knee arthroplasty (TKA). This study aims to provide a detailed history of perioperative opioid use patterns in a consecutive cohort of TKA patients. We also investigated the association between usage patterns and quality metrics throughout a TKA episode of care.

Methods: A retrospective analysis was performed on 338 consecutive TKAs conducted at our institution. Two cohorts were compared in this study - perioperative chronic opioid users and non-ch­­­ronic opioid users. Opioid use patterns and quality metrics were collected and analyzed over a 3-month preoperative and a 6-month postoperative period using the state’s prescription monitoring program.

Results: Fifty-four (16.0%) chronic opioid users were identified out of the total 338 patients included in the study. By the 6-month postoperative time point, chronic users were consuming 46.8 morphine-equivalents (mg/day) versus 6.2 morphine-equivalents (mg/day) doses of opioids in non-chronic users. A total of 37 (10.9%) patients were identified as chronic opioid users 6 months following surgery, 23 (23/37; 62.2%) of which were previously identified as preoperative chronic users. Both preoperative and postoperative chronic opioid users were significantly younger, experienced significantly longer lengths of stay (LOS), and had increased overall readmission rates and emergency room (ER) visits.

Conclusion: By better understanding patients’ opioid use patterns, the appropriate preoperative optimization protocols targeting at-risk opioid users can be implemented in order to alleviate the poorer quality outcomes associated with this population.