Observational studyPain medicine (Malden, Mass.)2020
Effect of Preoperative Opioid Use on Adverse Outcomes, Medical Spending, and Persistent Opioid Use Following Elective Total Joint Arthroplasty in the United States: A Large Retrospective Cohort Study of Administrative Claims Data.
Observational study in Pain medicine (Malden, Mass.), 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 34 papers.
What it found
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
34 citing papers in PubMed, 90 citations in OpenAlex.
- The Impact of Opioid-Related Disorder on Healthcare Resource Utilization Following Distal Radius Fracture Repair Surgery.Journal of hand surgery global online · 2026Article
- Pharmacists may facilitate opioid tapering before total hip or knee arthroplasty.Annals of joint · 2026Article
- Impact of opioid use disorder as a safety risk in elective total hip arthroplasty: an imperative for routine preoperative screening.Patient safety in surgery · 2025Article
- Preoperative Opioid Use Disorder Predicts Prolonged Ventilation, Central Line Placement, and Major Anesthesiology Complications After ACDF Surgery: A Big Data Analysis of 180,000 Cases.Journal of clinical medicine · 2025Article
- Persistent Opioid Use Following Major Orthopedic Surgery.Current pain and headache reports · 2025Review
- Opioid Use Disorder Significantly Increases Complications and Costs in Primary and Revision Total Knee Arthroplasty a Nationwide Analysis and the Case for Preoperative Screening.Journal of clinical medicine · 2025Article
- An overnight sensation: the effect of an acute introduction of a short-stay pathway on a previously compromised arthroplasty service.Bone & joint open · 2025Article
- The long-term impacts of opioid use before and after joint arthroplasty: matched cohort analysis of New Zealand linked register data.Family practice · 2024Article
- Do modifiable patient factors increase the risk of postoperative complications after total joint arthroplasty?Archives of orthopaedic and trauma surgery · 2024Article
- Does preoperative opioid use predict outcomes to 6 months following primary unilateral knee or hip arthroplasty for osteoarthritis? A data-linked retrospective study.Arthroplasty (London, England) · 2024Article
- Trends in incidence and average waiting time for arthroplasty from 1998-2021: an observational study of 282,367 patients from the Scottish arthroplasty project.Annals of the Royal College of Surgeons of England · 2024Observational
- Initial and Long-Term Prescribing of Opioids and Non-steroidal Anti-inflammatory Drugs Following Total Hip and Knee Arthroplasty.Geriatric orthopaedic surgery & rehabilitation · 2024Article
- Impact of Pre-operative Opioid Use on Racial Disparities in Adverse Outcomes Post Total Knee and Hip Arthroplasty.Journal of racial and ethnic health disparities · 2023Article
- Prolonged Opioid Use Following Distal Radius Fracture Fixation: Who Is at Risk and What are the Consequences?Journal of hand surgery global online · 2023Article
- Opioid prescriptions after knee replacement: a retrospective study of pathways and prognostic factors in the Swiss healthcare setting.BMJ open · 2023Article
- Preoperative and Postoperative Hyperalgesia in Dental Patients on Chronic Opioid Therapy: A Pilot Study.Anesthesia progress · 2023Article
- Article
- Preoperative Patient Optimization in Total Joint Arthroplasty-The Paradigm Shift from Preoperative Clearance: A Narrative Review.HSS journal : the musculoskeletal journal of Hospital for Special Surgery · 2022Review
- Factors Associated With Increasing Length of Stay for Rheumatoid Arthritis Patients Undergoing Total Hip Arthroplasty and Total Knee Arthroplasty.HSS journal : the musculoskeletal journal of Hospital for Special Surgery · 2022Article
- Article
Corrections and comments
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Authors and funding
5 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveBetween 17% and 40% of patients undergoing elective arthroplasty are preoperative opioid users. This US study analyzed patients in this population to illustrate the relationship between preoperative opioid use and adverse surgical outcomes.
designRetrospective study of administrative medical and pharmaceutical claims data. SUBJECTS: Adults (aged 18+) who received elective total knee, hip, or shoulder replacement in 2014-2015.
methodsA patient was a preoperative opioid user if opioid prescription fills occurred in two periods: 1-30 and 31-90 days presurgery. Zero-truncated Poisson (incidence rate ratio [IRR]), logistic (odds ratio [OR]), Cox (hazard ratio [HR]), and quantile regressions modeled the effects of preoperative opioid use and opioid dose, adjusted for demographics, comorbidities, and utilization.
resultsAmong 34,792 patients (38% hip, 58% knee, 4% shoulder), 6,043 (17.4%) were preoperative opioid users with a median morphine equivalent daily dose of 32 mg. Preoperative opioid users had increased length of stay (IRR = 1.03, 95% CI = 1.02 to 1.05), nonhome discharge (OR = 1.10, 95% CI = 1.00 to 1.21), and 30-day unplanned readmission (OR = 1.43, 95% CI = 1.17 to 1.74); experienced 35% higher surgical site infection (HR = 1.35, 95% CI = 1.14 to 1.59) and 44% higher surgical revision (HR = 1.44, 95% CI = 1.21 to 1.71); had a median $1,084 (95% CI = $833 to $1334) increase in medical spend during the 365 days after discharge; and had a 64% lower rate of opioid cessation (HR = 0.34, 95% CI = 0.33 to 0.35) compared with patients not filling two or more prescriptions across periods.
conclusionsPreoperative opioid users had longer length of stay, increased revision rates, higher spend, and persistent opioid use, which worsened with dose. Adverse outcomes after elective joint replacement may be reduced if preoperative opioid risk is managed through increased monitoring or opioid cessation.
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