Prolonged opioid use linked to patient safety concerns following knee surgery

Doctor with opioids
Long-term opioid use could lead to increased risk after total knee replacement surgery. (Getty/stevanovicigor)

A recent study conducted by the Brigham and Women’s Hospital in Boston looked into the connection between long-term preoperative opioid use and safety issues following a total knee replacement surgery.

Researchers looked at data from more than 300,000 patients aged 65 years of age or older, 7.2% of whom had a history of continuous opioid use 360 days prior to surgery. The findings, published in JAMA Network Open, reveal that these opioid users had higher risks of revision operations, vertebral fractures and opioid overdoses at 30 days after the operation compared with patients who were new to using opioids.

However, long-term users of the drug had no higher incidents of in-hospital or 30-day mortality rates than other patients.

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Researchers chose to look at total knee replacement specifically because prescription opioid use is common among patients with moderate to severe knee osteoarthritis in the time leading up to surgery. In fact, more than 40% of patients with osteoarthritis received an opioid prescription in 2009, according to the US Medicare Current Beneficiary Survey. Several studies have raised concerns that opioid use prior to total joint replacement affects postsurgical outcomes including persistent pain, stiffness, patient satisfaction and additional surgical procedures.

The study used a random sample of Medicare enrollee claims from 2010 through 2014. Although only just more than 7% of patients were continuous opioid users, 51% were intermittent opioid users prior to surgery. Specifically, at 30 days post-TKR, 5.3% of all patients had been readmitted to the hospital, 0.26% had died and 0.29% had undergone revision operations.  

Continuous opioid users in this study were more likely to be female, black and live in the South. They also had more comorbidities including diabetes, obesity, back pain, malignant tumors, cardiovascular disease, sleep disorder, psychiatric disorders and substance use disorder.

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The researchers concluded that the study results highlight the need for better understanding of patient characteristics associated with chronic opioid use to optimize preoperative assessment of overall risk.

“A considerable number of patients had continuous use of opioids in the year prior to TKR, and these continuous opioid users had a higher rate of short-term complications after TKR compared with opioid-naive patients,” the study said. “As such, evaluation of patients’ preoperative opioid use patterns may be helpful in planning a more rigorous monitoring strategy after a common elective surgical procedure, such as TKR.”