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Preoperative Chronic Opioid Users in Total Knee Arthroplasty—Which Patients Persistently Abuse Opiates Following Surgery?
- Source :
- The Journal of Arthroplasty. 33:107-112
- Publication Year :
- 2018
- Publisher :
- Elsevier BV, 2018.
-
Abstract
- Background Chronic opioid users pose a unique challenge for orthopedic surgeons, as they often report suboptimal outcomes following total knee arthroplasty (TKA). We aim at identifying risk factors associated with patients who were preoperative chronic opioid users and continued to use 6 months following TKA. Methods All preoperative chronic opioid users among 338 consecutive TKA cases performed at our institution between February and June 2016 were identified and divided into 2 cohorts: patients who (1) persistently used opioids and (2) discontinued use by the 6-month time point following surgery. Baseline characteristics were compared between cohorts in order to determine risk factors for persistent opioid use following TKA. Results Of the 338 patients, 53 (15.7%) were identified as preoperative chronic opioid users. Of these, 23 (43.4%) continued chronic opioid use 6 months following surgery, whereas 14 (4.9%) previously nonchronic users were identified as new chronic users at 6 months. Characteristics that were predictive of persistent opioid use included male gender, prior injury or surgery to the ipsilateral knee, current tobacco smoking status, and a history of psychiatric disorder. Opioid dose consumption of ≥12 mg/d morphine-equivalents over the 3 months leading up to surgery had an increased risk of persistent chronic opioid use by a factor of 6. Conclusion TKA candidates who have complicated medical, social, and surgical histories are at an increased risk of chronic opioid abuse postoperatively. By better understanding the risk factors associated with persistent chronic opioid use, targeted opioid reduction programs may be appropriately implemented to manage this high-risk population.
- Subjects :
- Male
medicine.medical_specialty
Knee Joint
Population
Total knee arthroplasty
Tobacco smoking status
03 medical and health sciences
0302 clinical medicine
Risk Factors
medicine
Humans
Orthopedics and Sports Medicine
Postoperative Period
Arthroplasty, Replacement, Knee
education
Male gender
Aged
Retrospective Studies
Aged, 80 and over
Pain, Postoperative
030222 orthopedics
education.field_of_study
Morphine
business.industry
Opiate Alkaloids
Opioid abuse
Middle Aged
Opioid-Related Disorders
Surgery
Analgesics, Opioid
Opioid
Baseline characteristics
Preoperative Period
Orthopedic surgery
Female
business
030217 neurology & neurosurgery
medicine.drug
Subjects
Details
- ISSN :
- 08835403
- Volume :
- 33
- Database :
- OpenAIRE
- Journal :
- The Journal of Arthroplasty
- Accession number :
- edsair.doi.dedup.....279959a0297f8cad7dbe24e4db19abab