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Prevalence and risk factors for prolonged opioid use after total joint arthroplasty: a systematic review, meta-analysis, and meta-regression

Archives of Orthopaedic and Trauma Surgery volume 141, pages 907–915 (2021)Cite this article

Abstract

Purpose

Opioids are a mainstay for pain management after total joint arthroplasty (TJA). The prevalence and risk factors for prolonged opioid use after TJA are important to understand to help slow the opioid epidemic. We aim to summarize and evaluate the prevalence and time trend of prolonged opioid use after TJA and pool its risk factors.

Methods

Following the preferred reporting items for systematic reviews and meta-analysis statement, we systematically searched PubMed, the Cochrane Library, and EMBASE, etc. from inception up to October 1, 2019. Cohort studies reporting risk factors for prolonged opioids use (≥ 3 months) after TJA were included. Studies characteristics, risk ratios (RR), and prevalence of prolonged opioid use were extracted and synthesized.

Results

A total of 15 studies were published between 2015 and 2019, with 416,321 patients included. 12% [95%CI 10–14%] of patients had prolonged opioid use after TJA and its time trend was associated with median enrollment years (P = 0.0013). Previous opioid use (RR = 1.73; P < 0.001), post-traumatic stress disorder (RR = 1.34; P < 0.001), benzodiazepine use (RR = 1.38; P < 0.001), tobacco abuse (RR = 1.26; P < 0.001), fibromyalgia (RR = 1.51; P < 0.001), and back pain (RR = 1.34; P < 0.001) were the largest effective risk factors for prolonged use of opioids.

Conclusions

To our knowledge, this is the first meta-analysis determining the risk factors of prolonged opioid use and characterizing its rate and time trend in TJA. Understanding risk factors for patients with higher potential for prolonged opioids use can be used to implement appropriate management strategies, reduce unsafe opioid prescriptions, and decrease the risk of prolonged opioid use after TJA.

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References

  1. Cross M, Smith E, Hoy D, Nolte S, Ackerman I, Fransen M, Bridgett L, Williams S, Guillemin F, Hill CL, Laslett LL, Jones G, Cicuttini F, Osborne R, Vos T, Buchbinder R, Woolf A, March L (2014) The global burden of hip and knee osteoarthritis: estimates from the global burden of disease 2010 study. Ann Rheum Dis 73(7):1323–1330. https://doi.org/10.1136/annrheumdis-2013-204763

    Article  PubMed  Google Scholar 

  2. Helmick CG, Felson DT, Lawrence RC, Gabriel S, Hirsch R, Kwoh CK, Liang MH, Kremers HM, Mayes MD, Merkel PA, Pillemer SR, Reveille JD, Stone JH (2008) Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part I. Arthritis Rheum 58(1):15–25. https://doi.org/10.1002/art.23177

    Article  PubMed  Google Scholar 

  3. Kendrick BJ, Bottomley NJ, Gill HS, Jackson WF, Dodd CA, Price AJ, Murray DW (2012) A randomised controlled trial of cemented versus cementless fixation in Oxford unicompartmental knee replacement in the treatment of medial gonarthrosis using radiostereometric analysis. Osteoarthr Cartil 20:S36–S37. https://doi.org/10.1016/j.joca.2012.02.566

    Article  Google Scholar 

  4. Health UDo, Services H (2018) HHS acting secretary declares public health emergency to address national opioid crisis. HHS gov https://www.hhsgov/about/news/2017/10/26/hhs-acting-secretary-declares-public-health-emergency-address-national-opioid-crisishtml. Published May 23

  5. Sloan M, Premkumar A, Sheth NP (2018) Projected volume of primary total joint arthroplasty in the US, 2014 to 2030. J Bone Jt Surg Am 100(17):1455–1460. https://doi.org/10.2106/jbjs.17.01617

    Article  Google Scholar 

  6. Vogt MT, Kwoh CK, Cope DK, Osial TA, Culyba M, Starz TW (2005) Analgesic usage for low back pain: impact on health care costs and service use. Spine 30(9):1075–1081. https://doi.org/10.1097/01.brs.0000160843.77091.07

    Article  PubMed  Google Scholar 

  7. Beswick AD, Wylde V, Gooberman-Hill R, Blom A, Dieppe P (2012) What proportion of patients report long-term pain after total hip or knee replacement for osteoarthritis? A systematic review of prospective studies in unselected patients. BMJ Open 2(1):e000435. https://doi.org/10.1136/bmjopen-2011-000435

    Article  PubMed  PubMed Central  Google Scholar 

  8. Hah JM, Sharifzadeh Y, Wang BM, Gillespie MJ, Goodman SB, Mackey SC, Carroll IR (2015) Factors associated with opioid use in a cohort of patients presenting for surgery. Pain Res Treat 2015:829696. https://doi.org/10.1155/2015/829696

    Article  PubMed  PubMed Central  Google Scholar 

  9. Franklin PD, Karbassi JA, Li W, Yang W, Ayers DC (2010) Reduction in narcotic use after primary total knee arthroplasty and association with patient pain relief and satisfaction. J Arthroplasty 25(6 Suppl):12–16. https://doi.org/10.1016/j.arth.2010.05.003

    Article  PubMed  Google Scholar 

  10. Surgeons AAoO (2018) Information statement: opioid use, misuse, and abuse in orthopaedic practice. 2015. October https://www.aaos.org/uploadedFiles/PreProduction/About/Opinion_Statements/advistmt/1045%20Opioid%20Use,%20Misuse,%20and%20Abuse%20in%20Practice pdf. Accessed

  11. Prentice HA, Inacio MCS, Singh A, Namba RS, Paxton EW (2019) Preoperative risk factors for opioid utilization after total hip arthroplasty. J Bone Jt Surg Am 101(18):1670–1678. https://doi.org/10.2106/jbjs.18.01005

    Article  Google Scholar 

  12. Khazi ZM, Lu Y, Patel BH, Cancienne JM, Werner B, Forsythe B (2020) Risk factors for opioid use after total shoulder arthroplasty. J Shoulder Elbow Surg 29(2):235–243. https://doi.org/10.1016/j.jse.2019.06.020

    Article  PubMed  Google Scholar 

  13. Kim KY, Anoushiravani AA, Chen KK, Roof M, Long WJ, Schwarzkopf R (2018) Preoperative chronic opioid users in total knee arthroplasty-which patients persistently abuse opiates following surgery? J Arthroplasty 33(1):107–112. https://doi.org/10.1016/j.arth.2017.07.041

    Article  PubMed  Google Scholar 

  14. Namba RS, Singh A, Paxton EW, Inacio MCS (2018) patient factors associated with prolonged postoperative opioid use after total knee arthroplasty. J Arthroplasty 33(8):2449–2454. https://doi.org/10.1016/j.arth.2018.03.068

    Article  PubMed  Google Scholar 

  15. Rao AG, Chan PH, Prentice HA, Paxton EW, Navarro RA, Dillon MT, Singh A (2018) Risk factors for postoperative opioid use after elective shoulder arthroplasty. J Shoulder Elbow Surg 27(11):1960–1968. https://doi.org/10.1016/j.jse.2018.04.018

    Article  PubMed  Google Scholar 

  16. Politzer CS, Kildow BJ, Goltz DE, Green CL, Bolognesi MP, Seyler TM (2018) Trends in opioid utilization before and after total knee arthroplasty. J Arthroplast 33(7s):S147–S153.e141. https://doi.org/10.1016/j.arth.2017.10.060

    Article  Google Scholar 

  17. Hadlandsmyth K, Vander Weg MW, McCoy KD, Mosher HJ, Vaughan-Sarrazin MS, Lund BC (2018) Risk for prolonged opioid use following total knee arthroplasty in veterans. J Arthroplast 33(1):119–123. https://doi.org/10.1016/j.arth.2017.08.022

    Article  Google Scholar 

  18. Bedard NA, Pugely AJ, Dowdle SB, Duchman KR, Glass NA, Callaghan JJ (2017) Opioid use following total hip arthroplasty: trends and risk factors for prolonged use. J Arthroplast 32(12):3675–3679. https://doi.org/10.1016/j.arth.2017.08.010

    Article  Google Scholar 

  19. Dwyer MK, Tumpowsky CM, Hiltz NL, Lee J, Healy WL, Bedair HS (2018) Characterization of post-operative opioid use following total joint arthroplasty. J Arthroplast 33(3):668–672. https://doi.org/10.1016/j.arth.2017.10.011

    Article  Google Scholar 

  20. Bedard NA, Pugely AJ, Westermann RW, Duchman KR, Glass NA, Callaghan JJ (2017) Opioid use after total knee arthroplasty: trends and risk factors for prolonged use. J Arthroplast 32(8):2390–2394. https://doi.org/10.1016/j.arth.2017.03.014

    Article  Google Scholar 

  21. Hansen CA, Inacio MCS, Pratt NL, Roughead EE, Graves SE (2017) Chronic use of opioids before and after total knee arthroplasty: a retrospective cohort study. J Arthroplast 32(3):811–817.e811. https://doi.org/10.1016/j.arth.2016.09.040

    Article  Google Scholar 

  22. Sun EC, Bateman BT, Memtsoudis SG, Neuman MD, Mariano ER, Baker LC (2017) Lack of association between the use of nerve blockade and the risk of postoperative chronic opioid use among patients undergoing total knee arthroplasty: evidence from the marketscan database. Anesth Analg 125(3):999–1007. https://doi.org/10.1213/ane.0000000000001943

    Article  PubMed  Google Scholar 

  23. Inacio MC, Hansen C, Pratt NL, Graves SE, Roughead EE (2016) Risk factors for persistent and new chronic opioid use in patients undergoing total hip arthroplasty: a retrospective cohort study. BMJ Open 6(4):e010664. https://doi.org/10.1136/bmjopen-2015-010664

    Article  PubMed  PubMed Central  Google Scholar 

  24. Goesling J, Moser SE, Zaidi B, Hassett AL, Hilliard P, Hallstrom B, Clauw DJ, Brummett CM (2016) Trends and predictors of opioid use after total knee and total hip arthroplasty. Pain 157(6):1259–1265. https://doi.org/10.1097/j.pain.0000000000000516

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  25. Kim SC, Choudhry N, Franklin JM, Bykov K, Eikermann M, Lii J, Fischer MA, Bateman BT (2017) Patterns and predictors of persistent opioid use following hip or knee arthroplasty. Osteoarthr Cartil 25(9):1399–1406. https://doi.org/10.1016/j.joca.2017.04.002

    CAS  Article  Google Scholar 

  26. Menendez ME, Ring D, Bateman BT (2015) Preoperative opioid misuse is associated with increased morbidity and mortality after elective orthopaedic surgery. Clin Orthop Relat Res 473(7):2402–2412. https://doi.org/10.1007/s11999-015-4173-5

    Article  PubMed  PubMed Central  Google Scholar 

  27. Morris BJ, Laughlin MS, Elkousy HA, Gartsman GM, Edwards TB (2015) Preoperative opioid use and outcomes after reverse shoulder arthroplasty. J Shoulder Elbow Surg 24(1):11–16. https://doi.org/10.1016/j.jse.2014.05.002

    Article  PubMed  Google Scholar 

  28. Mohamadi A, Chan JJ, Lian J, Wright CL, Marin AM, Rodriguez EK, von Keudell A, Nazarian A (2018) Risk factors and pooled rate of prolonged opioid use following trauma or surgery: a systematic review and meta-(regression) analysis. J Bone Jt Surg Am 100(15):1332–1340. https://doi.org/10.2106/jbjs.17.01239

    Article  Google Scholar 

  29. Workman EA, Hubbard JR, Felker BL (2002) Comorbid psychiatric disorders and predictors of pain management program success in patients with chronic pain. Prim Care Companion J Clin Psychiatry 4(4):137–140. https://doi.org/10.4088/pcc.v04n0404

    Article  PubMed  PubMed Central  Google Scholar 

  30. Eriksen WB, Brage S, Bruusgaard D (1997) Does smoking aggravate musculoskeletal pain? Scand J Rheumatol 26(1):49–54. https://doi.org/10.3109/03009749709065664

    CAS  Article  PubMed  Google Scholar 

  31. Nuesch E, Rutjes AW, Husni E, Welch V, Juni P (2009) Oral or transdermal opioids for osteoarthritis of the knee or hip. Cochrane Datab Syst Rev 4:Cd003115. https://doi.org/10.1002/14651858.CD003115.pub3

    Article  Google Scholar 

  32. Smith SR, Deshpande BR, Collins JE, Katz JN, Losina E (2016) Comparative pain reduction of oral non-steroidal anti-inflammatory drugs and opioids for knee osteoarthritis: systematic analytic review. Osteoarthr Cartil 24(6):962–972. https://doi.org/10.1016/j.joca.2016.01.135

    CAS  Article  Google Scholar 

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Funding

This study was supported through grants from the National Natural Science Foundation of China (81802210 and 81672219), National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University (Z20191008), the Key Project of Sichuan Science and Technology Department (2018SZ0223 and 2018SZ0250), and the National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University (Z2018B20).

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Affiliations

  1. Department of Orthopaedic Surgery, West China Hospital, West China Medical School, Sichuan University, Chengdu, 610041, Sichuan, China

    Limin Wu, Mingyang Li, Haibo Si, Yuan Liu, Peng Yang & Bin Shen

  2. Department of Orthopaedic Surgery and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China

    Yi Zeng

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  1. Limin Wu
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  2. Mingyang Li
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Correspondence to Bin Shen.

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Cite this article

Wu, L., Li, M., Zeng, Y. et al. Prevalence and risk factors for prolonged opioid use after total joint arthroplasty: a systematic review, meta-analysis, and meta-regression. Arch Orthop Trauma Surg 141, 907–915 (2021). https://doi.org/10.1007/s00402-020-03486-4

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  • DOI: https://doi.org/10.1007/s00402-020-03486-4

Keywords

  • Opioid
  • Prolonged
  • Long-term
  • Total joint arthroplasty
  • Risk factors
  • Prevalence