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J Arthroplasty. 2018 Jul;33(7S):S142-S146. doi: 10.1016/j.arth.2018.01.004. Epub 2018 Jan 16.

Patients at Risk: Preoperative Opioid Use Affects Opioid Prescribing, Refills, and Outcomes After Total Knee Arthroplasty.

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1
Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN.

Abstract

BACKGROUND:

The purpose of this study was to evaluate the effect of preoperative opioid use on opioid prescriptions, refills, and clinical outcomes after total knee arthroplasty (TKA).

METHODS:

A retrospective review identified 53 patients on preoperative opioids who were matched 1:2 to 106 opioid-naive patients undergoing primary TKA with at least 2-year follow-up. Opioid refills, Knee Society Score (preoperative and follow-up), morphine equivalent dose (MED) prescribed, and persistent opioid use were compared between groups.

RESULTS:

The average total MED prescribed at discharge was 1248 mg, ranging from 0 to 5600 mg. The average daily MED used before discharge was greater in the preoperative opioid group compared to the opioid-naive group (90 ± 75 mg vs 54 ± 42 mg; P = .001). The preoperative opioid group and opioid-naive group differed in terms of refills (1.3 ± 1.6 vs 0.4 ± 0.6; P = .0001), persistent opioid use (21 [39%] vs 5 [4%], P = .0001), postoperative KSS (85 ± 11 vs 90 ± 13; P = .01), and manipulations under anesthesia (4 [8%] vs 1 [1%], P = .03). Preoperative tramadol users had the same risk of refills, persistent opioid use, reduced KSS, and manipulation under anesthesia as those taking other opioids.

CONCLUSION:

Preoperative opioid users were discharged with less opioids, required more refills, were more likely to remain on opioids, and required more manipulations under anesthesia than opioid-naive patients. These risks extended to preoperative tramadol users.

KEYWORDS:

morphine equivalent dose; opioid abuse; preoperative opioid use; refill rate; total knee arthroplasty

PMID:
29402712
DOI:
10.1016/j.arth.2018.01.004
[Indexed for MEDLINE]

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