ArticleBMC anesthesiology2026
Association between sustained opioid use and survival or major adverse cardiovascular events after total knee arthroplasty: evidence from a population-based cohort.
Article in BMC anesthesiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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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.
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Abstract
objectiveTo examine whether long-term opioid use after total knee arthroplasty (TKA) is associated with subsequent risks of major adverse cardiovascular events (MACE) and all-cause mortality in patients with knee osteoarthritis (OA).
methodsThis retrospective, population-based cohort study used Taiwan’s Longitudinal Health Insurance Database (LHID) 2005 to identify patients with knee OA undergoing TKA (2002–2018). Opioid exposure was assessed during the 1-year post discharge window (long-term > 3 months vs. non-long-term < 3 months), and the index date was set at 360 days after discharge (landmark design). The primary outcome was first MACE after the index date. After 1:2 propensity score matching (PSM), adjusted hazard ratios (aHRs) were estimated using Cox models; Fine–Gray models were used for nonfatal components.
resultsIn the matched cohort (2,351 long-term vs. 4,702 non-long-term users), long-term opioid use was associated with higher risks of MACE (aHR = 1.16; 95% CI, 1.06–1.26) and all-cause mortality (aHR = 1.16; 95% CI, 1.05–1.29), as well as AMI (aHR = 1.30; 95% CI, 1.03–1.64) and CHF (aHR = 1.15; 95% CI, 1.00–1.32), but not ischemic or hemorrhagic stroke. Effect modification by Charlson Comorbidity Index (CCI) was observed for MACE (P-interaction = 0.0278) and mortality (P-interaction = 0.0006), with the strongest associations in CCI ≥ 5. Time-stratified analyses for MACE showed the excess risk was greatest early after the index date and remained significant through 1–5 years, with attenuation thereafter.
conclusionsLong-term opioid use after TKA was associated with increased risks of MACE and mortality, particularly among patients with high comorbidity burden, underscoring the importance of opioid-sparing strategies and closer cardiovascular risk assessment in patients requiring prolonged opioid therapy.
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