Opioid-dependent patients: increased complication rates after joint replacement

Poorer postoperative outcomes suggest that this patient group may benefit from targeted interventions.

Insight

• Patients who were addicted to opioids prior to total hip or knee replacement showed more postoperative complications, generated higher hospital costs, and were more likely to be discharged to a rehabilitation facility.

Why this matters

• This patient population could benefit from targeted interventions to improve outcomes.

Study design

• US retrospective cohort study with 3,545,565  Patients undergoing elective, unilateral, primary hip or knee total arthroplasty in community hospitals due to osteoarthritis (2016–2019)
• Opioid-dependent patients were defined by diagnostic codes for opioid use disorder or long-term opioid use.
• Key findings: postoperative complications in hospital, length of stay, total costs adjusted for inflation
• Funding: None

Key results

• 2,6 % of the cohort were opioid addicted prior to joint replacement surgery.
• Compared to non-dependent counterparts, opioid-dependent patients who underwent total hip or knee replacement had higher adjusted postoperative risks for:
  • by 40 % or30 % for respiratory complications
  • um 80 % or 80 % for gastrointestinal complications
  • by 10 % or 20 % for urinary tract infections
  • by 50 % or 40 % for blood transfusions
  • by 70 % or 60 % for deep vein thrombosis
• The average total hospital costs were opioid-dependent patients were 6.5 % higher than non-dependent patients (p <0.001), and hospitalizations were longer in the former patients (2.15 vs. 2.03  Days; p <0.001).
• Opioid-dependent patients were also more likely to be discharged to a rehabilitation facility (17.8 % vs. 15.7 %; p <0.001).

• by 40 % or30 % for respiratory complications
• um 80 % or 80 % for gastrointestinal complications
• by 10 % or 20 % for urinary tract infections
• by 50 % or 40 % for blood transfusions
• by 70 % or 60 % for deep vein thrombosis

Limitations

• The study was based on administrative data.
• The diagnostic codes used may have led to an overestimation of cases of opioid use disorder.
• No details were available about the surgical procedures and opioid use.

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