Patterns of pre-operative opioid use affect the risk for complications after total joint replacement

Abstract Preoperative opioid use has been shown to increase the risk for complications following total joint arthroplasty (TJA); however, these studies have not always accounted for differences in co-morbidities and socio-demographics between patients that use opioids and those that do not. They hav...

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Autores principales:	Bheeshma Ravi, Daniel Pincus, Ruth Croxford, Timothy Leroux, JMichael Paterson, Gillian Hawker, Donald A. Redelmeier
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/96b540beed83446bbc1d89d7be64c534
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spelling	oai:doaj.org-article:96b540beed83446bbc1d89d7be64c5342021-11-14T12:22:19ZPatterns of pre-operative opioid use affect the risk for complications after total joint replacement10.1038/s41598-021-01179-52045-2322https://doaj.org/article/96b540beed83446bbc1d89d7be64c5342021-11-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-01179-5https://doaj.org/toc/2045-2322Abstract Preoperative opioid use has been shown to increase the risk for complications following total joint arthroplasty (TJA); however, these studies have not always accounted for differences in co-morbidities and socio-demographics between patients that use opioids and those that do not. They have also not accounted for the variation in degree of pre-operative use. The objective of this study was to determine if preoperative opioid use is associated with risk for surgical complications after TJA, and if this association varied by degree of use. Population-based retrospective cohort study. Older adult patients undergoing primary TJA of the hip, knee and shoulder for osteoarthritis between 2002 and 2015 in Ontario, Canada were identified. Using accepted definitions, patients were stratified into three groups according to their preoperative opioid use: no use, intermittent use and chronic use. The primary outcome was the occurrence of a composite surgical complication (surgical site infection, dislocation, revision arthroplasty) or death within a year of surgery. Intermittent and chronic users were matched separately to non-users in a 1:1 ratio, matching on TJA type plus a propensity score incorporating patient and provider factors. Overall, 108,067 patients were included in the study; 10% (N = 10,441) used opioids on a chronic basis before surgery and 35% (N = 37,668) used them intermittently. After matching, chronic pre-operative opioid use was associated with an increased risk for complications after TJA (HR 1.44, p = 0.001) relative to non-users. Overall, less than half of patients undergoing TJA used opioids in the year preceding surgery; the majority used them only intermittently. While chronic pre-operative opioid use is associated with an increased risk for complications after TJA, intermitted pre-operative use is not.Bheeshma RaviDaniel PincusRuth CroxfordTimothy LerouxJMichael PatersonGillian HawkerDonald A. RedelmeierNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-8 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Bheeshma Ravi Daniel Pincus Ruth Croxford Timothy Leroux JMichael Paterson Gillian Hawker Donald A. Redelmeier Patterns of pre-operative opioid use affect the risk for complications after total joint replacement
description	Abstract Preoperative opioid use has been shown to increase the risk for complications following total joint arthroplasty (TJA); however, these studies have not always accounted for differences in co-morbidities and socio-demographics between patients that use opioids and those that do not. They have also not accounted for the variation in degree of pre-operative use. The objective of this study was to determine if preoperative opioid use is associated with risk for surgical complications after TJA, and if this association varied by degree of use. Population-based retrospective cohort study. Older adult patients undergoing primary TJA of the hip, knee and shoulder for osteoarthritis between 2002 and 2015 in Ontario, Canada were identified. Using accepted definitions, patients were stratified into three groups according to their preoperative opioid use: no use, intermittent use and chronic use. The primary outcome was the occurrence of a composite surgical complication (surgical site infection, dislocation, revision arthroplasty) or death within a year of surgery. Intermittent and chronic users were matched separately to non-users in a 1:1 ratio, matching on TJA type plus a propensity score incorporating patient and provider factors. Overall, 108,067 patients were included in the study; 10% (N = 10,441) used opioids on a chronic basis before surgery and 35% (N = 37,668) used them intermittently. After matching, chronic pre-operative opioid use was associated with an increased risk for complications after TJA (HR 1.44, p = 0.001) relative to non-users. Overall, less than half of patients undergoing TJA used opioids in the year preceding surgery; the majority used them only intermittently. While chronic pre-operative opioid use is associated with an increased risk for complications after TJA, intermitted pre-operative use is not.
format	article
author	Bheeshma Ravi Daniel Pincus Ruth Croxford Timothy Leroux JMichael Paterson Gillian Hawker Donald A. Redelmeier
author_facet	Bheeshma Ravi Daniel Pincus Ruth Croxford Timothy Leroux JMichael Paterson Gillian Hawker Donald A. Redelmeier
author_sort	Bheeshma Ravi
title	Patterns of pre-operative opioid use affect the risk for complications after total joint replacement
title_short	Patterns of pre-operative opioid use affect the risk for complications after total joint replacement
title_full	Patterns of pre-operative opioid use affect the risk for complications after total joint replacement
title_fullStr	Patterns of pre-operative opioid use affect the risk for complications after total joint replacement
title_full_unstemmed	Patterns of pre-operative opioid use affect the risk for complications after total joint replacement
title_sort	patterns of pre-operative opioid use affect the risk for complications after total joint replacement
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/96b540beed83446bbc1d89d7be64c534
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Patterns of pre-operative opioid use affect the risk for complications after total joint replacement

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