Patterns and predictors of persistent opioid use following hip or knee arthroplasty
Seoyoung C Kim, MD, ScD, MSCE,1,2 Niteesh Choudhry, MD, PhD,1 Jessica M Franklin, PhD,1 Katsiaryna Bykov, PharmD, MS,1 Matthias Eikermann, MD,3 Joyce Lii, MS, MA,1 Michael A Fischer, MD, MS,1 and Brian T Bateman, MD, MSc1,3Hip Knee
Objective
The relationship between arthroplasty and long-term opioid use in patients with knee or hip osteoarthritis is not well studied. We examined the prevalence, patterns and predictors of persistent opioid use after hip or knee arthroplasty.
Method
Using claims data (2004–2013) from a U.S. commercial health plan, we identified adults who underwent hip or knee arthroplasty and filled ≥1 opioid prescription within 30 days after the surgery. We defined persistent opioid users as patients who filled ≥1 opioid prescription every month during the 1-year postoperative period based on group-based trajectory models. Multivariable logistic regression was used to determine preoperative predictors of persistent opioid use after surgery.
Results
We identified 57,545 patients who underwent hip or knee arthroplasty. The mean±SD age was 61.5±7.8 years and 87.1% had any opioid use preoperatively. Overall, 7.6% persistently used opioids after the surgery. Among patients who used opioids in 80% of the time for ≥4 months preoperatively (n=3,023), 72.1% became persistent users. In multivariable analysis, knee arthroplasty vs. hip, a longer hospitalization stay, discharge to a rehabilitation facility, preoperative opioid use (e.g., a longer duration and greater dosage and frequency), a higher comorbidity score, back pain, rheumatoid arthritis, fibromyalgia, migraine and smoking, and benzodiazepine use at baseline were strong predictors for persistent opioid use (C-statistic=0.917).
Conclusion
Over 7% of patients persistently used opioids in the year after hip or knee arthroplasty. Given the adverse health effects of persistent opioid use, strategies need to be developed to prevent persistent opioid use after this common surgery.
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