Opioid Use After Total Knee Arthroplasty: Trends and Risk Factors for Prolonged Use.
BACKGROUND
The United States is in the midst of an opioid epidemic. Little is known about perioperative opioid use for total knee arthroplasty (TKA). The purpose of this study was to identify rates of preoperative opioid use, evaluate postoperative trends and identify risk factors for prolonged use after TKA.


METHODS
Patients who underwent primary TKA from 2007-2014 were identified within the Humana database. Postoperative opioid use was measured by monthly prescription refill rates. A preoperative opioid user (OU) was defined by history of opioid prescription within 3 months prior to TKA and a non-opioid user (NOU) was defined by no history of prior opioid use. Rates of opioid use were trended monthly for one year postoperatively for all cohorts.


RESULTS
73,959 TKA patients were analyzed and 23,532 patients (31.2%) were OU. OU increased from 30.1% in 2007 to 39.3% in 2014 (P < .001). Preoperative opioid use was the strongest predictor for prolonged opioid use following TKA, with OU filling significantly more opioid prescriptions than NOU at every time point analyzed. Younger age, female sex and other intrinsic factors were found to significantly increase the rate of opioid refilling following TKA throughout the postoperative year.


CONCLUSION
Approximately one-third of TKA patients use opioids within 3 months prior to surgery and this percentage has increased over 9% during the years included in this study. Preoperative opioid use was most predictive of increased refills of opioids following TKA. However, other intrinsic patient characteristics were also predictive of prolonged opioid use.
['Bedard|Nicholas A|NA|', 'Pugely|Andrew J|AJ|', 'Westermann|Robert W|RW|', 'Duchman|Kyle R|KR|', 'Glass|Natalie A|NA|', 'Callaghan|John J|JJ|']
D000368:Aged D000701:Analgesics, Opioid D019645:Arthroplasty, Replacement, Knee D015331:Cohort Studies D011307:Drug Prescriptions D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D009293:Opioid-Related Disorders D059408:Pain Management D059035:Perioperative Period D011184:Postoperative Period D057234:Preoperative Period D012307:Risk Factors
opioid total knee arthroplasty trends risk factors narcotic