CORR Insights®: NarxCare Scores Greater Than 300 Are Associated with Adverse Outcomes After Primary THA

The study by Emara and colleagues [⁴] focuses on the problems that arise when opioid, sedative, and stimulant drugs are misused by patients with end-stage hip osteoarthritis. As we think about this problem, though, we have to remember that inappropriate use often begins with physician prescription patterns; in general, our patients can’t misuse drugs that we don’t prescribe to them. All the same, the misuse epidemic continues to be a major public health problem in the United States [⁵], and patients with end-stage hip and knee osteoarthritis certainly experience the fallout of this epidemic [²]. Understanding the implications of misuse of these potent medications is critically important if we are to develop and implement interventions that will reduce their harms.

The current study certainly is not the first to show the adverse effects of taking opioids on outcomes of THA patients. However, it is worthy of our attention for two main reasons. First, the data used in this study are recent, highlighting the continued high use of opioids among end-stage hip osteoarthritis patients undergoing THA. Second, the substantial effect these medications have on postoperative healthcare utilization is further explored using a scalar measure, the widely available NarxCare score, which allows for more accurate quantitative assessment than previously had been possible. The authors found that a threshold of 300 or higher on the NarxCare score was associated with at least a doubling of the odds of 90-day all-cause readmission, procedure-related readmission, length of stay > 2 days, and non-home discharge compared with those below this threshold. The NarxCare score seems to provide surgeons with a more precise assessment of patients’ use of opioid, sedative, and stimulant drugs than we’ve had before; it’s a good tool, for an important job. With that in mind, I believe that surgeons should pay close attention to this scalar score when screening patients before surgery.