Accuracy of Patient-Reported Preoperative Opioid Use and Impact on Continued Opioid Use After Outpatient Arthroplasty

The opioid epidemic has created a national healthcare crisis, and little is known about the accuracy of self-reported narcotic usage in arthroplasty. The purpose of this study is to evaluate the accuracy of self-reported opioid usage in patients undergoing outpatient arthroplasty.

A retrospective review was conducted on all primary unilateral arthroplasty procedures performed in 2018 at a free-standing ambulatory surgery center, yielding a cohort of 959 arthroplasties. Patient’s prescription records were queried in the Ohio Automated Rx Reporting System for 3 months before surgery and minimum 9 months after surgery. These data were cross-referenced against the patient-reported preoperative use of narcotics. Three groups were evaluated: (G1) no preoperative narcotics, (G2) accurately self-reported on narcotics, and (G3) on narcotics but did not disclose.

One hundred fourteen patients (12%) were on preoperative opioids based on the Ohio Automated Rx Reporting System query, with only 35 of these patients (31%) self-reporting. G2 had significantly lower postoperative knee range of motion, Knee Society Pain score, Knee Society Clinical score, Knee Society Functional score, Harris Hip Score, and University of California Los Angeles activity scores than G1. Overnight stays occurred in 1.2% of patients in G1, 3% of patients in G2 ( P = .5), and 6.3% of patient in G3 ( P = .002). All aspects of postoperative narcotic use were significantly higher in G2 and G3 compared to G1. The relative risk for narcotic refill after 90 days in G2 was 4.6 (95% confidence interval 3.7-5.8, P < .001).

The majority of patients on preoperative narcotics did not disclose their use. Patients on narcotics preoperatively had significantly greater postoperative narcotic use including refills, total morphine milliequivalent, and risk of being on narcotics 90 days after surgery.