The Impact of Preoperative Opioid Use Disorder on Complications and Costs following Primary Total Hip and Knee Arthroplasty
Introduction. Multiple studies have demonstrated that patients taking opioids in the preoperative period are at elevated risk for complications following total hip (THA) and knee (TKA) arthroplasty. However, the incidence and impact of opioid use disorder (OUD) among these patients—both clinically a...
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| Format: | Article |
| Language: | English |
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Wiley
2019-01-01
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| Series: | Advances in Orthopedics |
| Online Access: | http://dx.doi.org/10.1155/2019/9319480 |
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| author | Jacob M. Wilson Kevin X. Farley Matthew Aizpuru Eric R. Wagner Thomas L. Bradbury George N. Guild |
| author_facet | Jacob M. Wilson Kevin X. Farley Matthew Aizpuru Eric R. Wagner Thomas L. Bradbury George N. Guild |
| author_sort | Jacob M. Wilson |
| collection | DOAJ |
| description | Introduction. Multiple studies have demonstrated that patients taking opioids in the preoperative period are at elevated risk for complications following total hip (THA) and knee (TKA) arthroplasty. However, the incidence and impact of opioid use disorder (OUD) among these patients—both clinically and fiscally—remain unknown. The purpose of this study was to investigate this relationship. Methods. The Nationwide Readmission Database (NRD) was used to identify patients undergoing THA and TKA from 2011 to 2015. Coarsened exact matching was used to statistically match the OUD and non-OUD cohorts. Further analysis was then conducted on matched cohorts with multivariate analysis. The incidence of OUD was also determined, and the costs associated with this comorbidity were calculated. Results. The incidence of OUD in arthroplasty patients increased 80% over the study period. OUD patients had higher odds of prosthetic joint infection (OR 1.55, 95% CI 1.23–1.94), wound complication (OR 1.40, 95% CI 1.12–1.76), prosthetic complication (OR 1.37, 95% CI 1.10–1.70), and revision surgery (OR 1.47, 95% CI 1.19–1.81). OUD patients also had longer length of stays (TKA: +0.67 days; THA: +1.09 days), higher readmission (OR 1.60, 95% CI 1.43–1.79), and increased 90-day costs (TKA: +$3,602 [95% CI $3,138–4,065]; THA: +4,527 [95% CI $3,593–4,920). Conclusion. Opioid use disorder is becoming a more common comorbidity among THA and TKA patients. This is concerning as it represents a significant risk factor for postoperative complication. It additionally confers increased perioperative costs. Patients with OUD should be counseled on their elevated risk, and future work will be needed to determine if this is a modifiable risk factor. |
| format | Article |
| id | doaj-art-801623bb06fb40fa9157f8e0e0ae9e2b |
| institution | Kabale University |
| issn | 2090-3464 2090-3472 |
| language | English |
| publishDate | 2019-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Advances in Orthopedics |
| spelling | doaj-art-801623bb06fb40fa9157f8e0e0ae9e2b2025-02-03T01:27:42ZengWileyAdvances in Orthopedics2090-34642090-34722019-01-01201910.1155/2019/93194809319480The Impact of Preoperative Opioid Use Disorder on Complications and Costs following Primary Total Hip and Knee ArthroplastyJacob M. Wilson0Kevin X. Farley1Matthew Aizpuru2Eric R. Wagner3Thomas L. Bradbury4George N. Guild5Department of Orthopaedic Surgery, Emory Orthopaedics & Spine Center, 59 S Executive Park NW, Atlanta, GA 30329, USADepartment of Orthopaedic Surgery, Emory Orthopaedics & Spine Center, 59 S Executive Park NW, Atlanta, GA 30329, USAEmory School of Medicine, 201 Dowman Dr., Atlanta, GA 30322, USADepartment of Orthopaedic Surgery, Emory Orthopaedics & Spine Center, 59 S Executive Park NW, Atlanta, GA 30329, USADepartment of Orthopaedic Surgery, Emory Orthopaedics & Spine Center, 59 S Executive Park NW, Atlanta, GA 30329, USADepartment of Orthopaedic Surgery, Emory Orthopaedics & Spine Center, 59 S Executive Park NW, Atlanta, GA 30329, USAIntroduction. Multiple studies have demonstrated that patients taking opioids in the preoperative period are at elevated risk for complications following total hip (THA) and knee (TKA) arthroplasty. However, the incidence and impact of opioid use disorder (OUD) among these patients—both clinically and fiscally—remain unknown. The purpose of this study was to investigate this relationship. Methods. The Nationwide Readmission Database (NRD) was used to identify patients undergoing THA and TKA from 2011 to 2015. Coarsened exact matching was used to statistically match the OUD and non-OUD cohorts. Further analysis was then conducted on matched cohorts with multivariate analysis. The incidence of OUD was also determined, and the costs associated with this comorbidity were calculated. Results. The incidence of OUD in arthroplasty patients increased 80% over the study period. OUD patients had higher odds of prosthetic joint infection (OR 1.55, 95% CI 1.23–1.94), wound complication (OR 1.40, 95% CI 1.12–1.76), prosthetic complication (OR 1.37, 95% CI 1.10–1.70), and revision surgery (OR 1.47, 95% CI 1.19–1.81). OUD patients also had longer length of stays (TKA: +0.67 days; THA: +1.09 days), higher readmission (OR 1.60, 95% CI 1.43–1.79), and increased 90-day costs (TKA: +$3,602 [95% CI $3,138–4,065]; THA: +4,527 [95% CI $3,593–4,920). Conclusion. Opioid use disorder is becoming a more common comorbidity among THA and TKA patients. This is concerning as it represents a significant risk factor for postoperative complication. It additionally confers increased perioperative costs. Patients with OUD should be counseled on their elevated risk, and future work will be needed to determine if this is a modifiable risk factor.http://dx.doi.org/10.1155/2019/9319480 |
| spellingShingle | Jacob M. Wilson Kevin X. Farley Matthew Aizpuru Eric R. Wagner Thomas L. Bradbury George N. Guild The Impact of Preoperative Opioid Use Disorder on Complications and Costs following Primary Total Hip and Knee Arthroplasty Advances in Orthopedics |
| title | The Impact of Preoperative Opioid Use Disorder on Complications and Costs following Primary Total Hip and Knee Arthroplasty |
| title_full | The Impact of Preoperative Opioid Use Disorder on Complications and Costs following Primary Total Hip and Knee Arthroplasty |
| title_fullStr | The Impact of Preoperative Opioid Use Disorder on Complications and Costs following Primary Total Hip and Knee Arthroplasty |
| title_full_unstemmed | The Impact of Preoperative Opioid Use Disorder on Complications and Costs following Primary Total Hip and Knee Arthroplasty |
| title_short | The Impact of Preoperative Opioid Use Disorder on Complications and Costs following Primary Total Hip and Knee Arthroplasty |
| title_sort | impact of preoperative opioid use disorder on complications and costs following primary total hip and knee arthroplasty |
| url | http://dx.doi.org/10.1155/2019/9319480 |
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