Preoperative Opioids and the Dose-Dependent Effect on Outcomes After Total Hip Arthroplasty

Background: The purpose of this study is to identify the preoperative daily opioid dose associated with increased complications after primary total hip arthroplasty (THA). Methods: Primary THA patients in the Humana claims database (2007-2020) with an opioid prescription within 3 months prior to surgery were identified. Patients were stratified based on daily opioid dose: Tier 1, <5 milligram morphine equivalents (MME); Tier 2, 5-10 MME; Tier 3, 11-25 MME; Tier 4, 26-50 MME; Tier 5, >50 MME. Each tier was matched 1:1 to opioid-naive patients. Emergency department (ED) visits, readmissions, and postoperative complications were compared. Results: In total, 67,719 patients using preoperative opioids were identified and matched. 17.0% of patients using preoperative opioids visited the ED within 90 days, compared to 13.3% of opioid-naive patients (P <.001). About 9.5% of patients using preoperative opioids were readmitted within 90 days, compared to 7.4% of opioid-naive patients (P <.001). When stratified by tier, opioid users in all tiers had higher risk of ED visits and readmission. Rates of superficial infection, periprosthetic joint infection, and dislocation were increased in patients taking preoperative opioids in Tiers 2 through 5. Patients in Tiers 3 through 5 had an increased risk of revision surgery. Conclusion: Preoperative opioid use is associated with a dose-dependent increase in complications after THA. Just one 5 mg hydrocodone tablet daily leads to a significant increase in ED visits and readmission, while higher doses are associated with dislocation, superficial infection, periprosthetic joint infection, and revision surgery. Continued education regarding the harmful effects of opioids prescribed for the nonoperative treatment of osteoarthritis is still needed. (C) 2021 Elsevier Inc. All rights reserved.

Automated summary

This study identifies the relationship between preoperative opioid use and increased complications after primary total hip arthroplasty (THA). The results show that higher opioid doses are associated with a higher risk of emergency department visits, readmissions, dislocation, infection, and revision surgery. Continued education on the harmful effects of opioids prescribed for nonoperative treatment of osteoarthritis is still necessary.