Evidence map›Paper›PMID 37556071›Full record

ArticlePain and therapy2023

Preoperative Versus Perioperative Risk Factors for Delayed Pain and Opioid Cessation After Total Joint Arthroplasty: A Prospective Cohort Study.

Jennifer M Hah, Julien D Veron Vialard, Bradley Efron, Sean C Mackey, Ian R Carroll, Derek F Amanatullah, Balasubramanian Narasimhan, Tina Hernandez-Boussard

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Pain and therapy, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
0.3field-weighted citation impact, top 39% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed, 1 citations in OpenAlex.

  1. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 2 institutions in 1 country.

Jennifer M HahDivision of Pain Medicine, Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University, Stanford, CA, USA. jhah@stanford.edu.ORCID http://orcid.org/0000-0002-9739-3968
Julien D Veron VialardInstitute for Computational and Mathematical Engineering, Stanford University, Stanford, CA, USA.
Bradley EfronDepartments of Statistics, Stanford University, Stanford, CA, USA.
Sean C MackeyDivision of Pain Medicine, Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University, Stanford, CA, USA.
Ian R CarrollDivision of Pain Medicine, Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University, Stanford, CA, USA.
Derek F AmanatullahDepartment of Orthopaedic Surgery, Stanford University, Stanford, CA, USA.
Balasubramanian NarasimhanDepartments of Statistics, Stanford University, Stanford, CA, USA.
Tina Hernandez-BoussardDepartments of Biomedical Data Science, Stanford University, Stanford, CA, USA.
Stanford University · USStanford Medicine · US

Funding

Integrating Tailored Postoperative Opioid Tapering and Pain Management Support for Patients on Long-Term Opioid Use Presenting for Spine Surgery (MIRHIQL)R01DA058694 · NIDA · STANFORD UNIVERSITY · PI Jennifer Hah · 2023 to 2026
$4.5M
Psychological Risk Factors for Persistent Opioid Use and Prevention of Chronic Opioid Use and Misuse After Surgery: Postoperative Motivational Interviewing and Guided Opioid WeaningR01DA045027 · NIDA · STANFORD UNIVERSITY · PI HAH, JENNIFER · 2018 to 2022
$2.6M
Neuroimaging and Mentoring in Translational Pain ResearchK24DA029262 · NIDA · STANFORD UNIVERSITY · PI MACKEY, SEAN C · 2010 to 2019
$1.9M
Psychological Factors Contributing to Persistent Opioid Use After SurgeryK23DA035302 · NIDA · STANFORD UNIVERSITY · PI HAH, JENNIFER · 2013 to 2017
$903k
NIDA NIH HHS K23 DA035302NIDA NIH HHS K24 DA029262NIDA NIH HHS R01 DA045027NIDA NIH HHS R01DA045027NIDA NIH HHS R01 DA058694
6 · The paper itself

Abstract

introductionThe evolution of pre- versus postoperative risk factors remains unknown in the development of persistent postoperative pain and opioid use. We identified preoperative versus comprehensive perioperative models of delayed pain and opioid cessation after total joint arthroplasty including time-varying postoperative changes in emotional distress. We hypothesized that time-varying longitudinal measures of postoperative psychological distress, as well as pre- and postoperative use of opioids would be the most significant risk factors for both outcomes.

methodsA prospective cohort of 188 patients undergoing total hip or knee arthroplasty at Stanford Hospital completed baseline pain, opioid use, and emotional distress assessments. After surgery, a modified Brief Pain Inventory was assessed daily for 3 months, weekly thereafter up to 6 months, and monthly thereafter up to 1 year. Emotional distress and pain catastrophizing were assessed weekly to 6 months, then monthly thereafter. Stepwise multivariate time-varying Cox regression modeled preoperative variables alone, followed by all perioperative variables (before and after surgery) with time to postoperative opioid and pain cessation.

resultsThe median time to opioid and pain cessation was 54 and 152 days, respectively. Preoperative total daily oral morphine equivalent use (hazard ratio-HR 0.97; 95% confidence interval-CI 0.96-0.98) was significantly associated with delayed postoperative opioid cessation in the perioperative model. In contrast, time-varying postoperative factors: elevated PROMIS (Patient-Reported Outcomes Measurement Information System) depression scores (HR 0.92; 95% CI 0.87-0.98), and higher Pain Catastrophizing Scale scores (HR 0.85; 95% CI 0.75-0.97) were independently associated with delayed postoperative pain resolution in the perioperative model.

conclusionsThese findings highlight preoperative opioid use as a key determinant of delayed postoperative opioid cessation, while postoperative elevations in depressive symptoms and pain catastrophizing are associated with persistent pain after total joint arthroplasty providing the rationale for continued risk stratification before and after surgery to identify patients at highest risk for these distinct outcomes. Interventions targeting these perioperative risk factors may prevent prolonged postoperative pain and opioid use.

Indexed as

Chronic postoperative opioid useChronic postoperative painPersistent post-surgical opioid usePersistent post-surgical painTotal hip replacementTotal knee replacement

Identifiers

PMID37556071
PMCPMC10444739
OpenAlexW4385684363

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.