Patterns of Prescription Opioid Use Before Total Hip and Knee Replacement Among US Medicare Enrollees

OBJECTIVE:

To examine patterns of prescription opioid use before TJR and factors associated with continuous use of opioids before TJR.

DESIGN:

We conducted an observational cohort study among Medicare enrollees aged ≥65 years who underwent TJR between 2010 and 2014. Preoperative opioid use was defined as having any opioid prescription in the 12-month period before TJR. Patients who had an opioid prescription every month for a 12-month period were defined as continuous users. We examined patients’ demographics, pain-related conditions, medication use, other comorbidities, healthcare utilization and their association with use of opioids before TJR.

RESULTS:

A total of 473,781 patients underwent TJR: 155,516 THR and 318,265 TKR. Among the total cohort, 60.2% patients had any use of opioids and of those, 12.4% used opioids at least once a month continuously over the 12-month baseline period. Correlates of continuous opioid use included African American race (OR=2.14, 95% CI=2.01-2.28, compared to White patients), history of drug abuse (OR=5.18, 95% CI=3.95-6.79) and back pain (OR=2.32, 95% CI=2.24-2.39).

CONCLUSIONS:

In this large cohort of patients undergoing TJR, over 60% ever used opioids and 12.4% of them continuously used opioids in the 12-month prior to surgery. Utilization of opioids became more frequent and high-dosed near the surgery. History of drug abuse, back pain, and African American race were strongly associated with continuous use of opioids preoperatively. Further research is needed to determine short-term and long-term risks of preoperative use of opioids in TJR patients and to optimize pre- and post-TJR pain management of patients with arthritis.