Patients Using Opioids Before Joint Replacement More Costly

A recent study presented at the AAPM 2018 Annual Meeting found that patients who use opioids before elective joint replacement surgery have higher health care costs and longer length of stay. 

In order to analyze how elective joint replacement surgical outcomes were impacted by preoperative use of opioids, the researchers conducted a retrospective study of 34,792 adult joint replacement patients. They defined opioid users as any patient that had opioid prescription fills within 1 to 30 days before surgery, and 31 to 90 days before surgery. Researchers used statistical analysis to determine the incident risk ratio for length of stay, surgical revision, and medical spending. Results were adjusted for numerous factors, including tobacco use, behavioral health, and surgical location. 

Within the study cohort, 17% of patients were preoperative opioid users, with median morphine equivalent daily doses of 32 mg. The researchers found that the relative risk of longer length of stay was higher among these patients (IRR = 1.03). They also determined that surgical revision was more common in the opioid user group, with 3.2% of procedures requiring revision, compared to 1.9% of non-opioid users. Furthermore, opioid users had a 44% increase in risk of surgical revision within 6 months.

Health care costs were also determined to be greater among opioid users. The researchers found that patients with preoperative opioid use had a $1084 increase in median medical spending within 1 year of discharge.  

“Preoperative opioid users had longer length-of-stay, increased revision, and higher spend,” Meridith Blevins Peratikos, MS, director of Statistics and Scientific Collaboration at axialHealthcare, and colleagues concluded. “Adverse outcomes following elective joint replacement may be reduced if preoperative opioid risk is managed through increased monitoring or opioid cessation.”

—David Costill