Health Policy & EconomicsPreoperative Opiate Use Independently Predicts Narcotic Consumption and Complications After Total Joint Arthroplasty
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Patients and Methods
We prospectively evaluated a consecutive series of 802 elective, primary THA (n = 273) and TKA (n = 529) patients at a single institution over a 9-month period. This study was approved and conducted according to the guidelines set by our institutional review board. Patients aged <18 years and those who underwent arthroplasty procedures for fracture or malignancy were excluded from the study. There were 324 men and 478 women with a mean age of 62.3 years (range, 20-92 years). Preoperative
Results
In this consecutive series of unselected patients undergoing primary THA and TKA, 266 patients (33%) required IV narcotic rescue medications. One hundred eighty patients required rescue on day 0, 77 patients on day 1, 7 on day 2, and 2 on day 3 postoperatively. Hydromorphone was the most common rescue narcotic administered. After surgery, 183 TKAs (34.6%) compared with 83 THAs (30.4%) patients required additional opioids (P = .251). The average BMI in patients who required IV narcotic rescue
Discussion
Although advances in pain management have decreased postoperative opioid requirements in patients undergoing THA and TKA [21], [22], [23], utilization in patients undergoing THA or TKA remains high. The American Academy of Orthopaedic Surgeons along with other public health agencies has advocated for a reduction in opioid prescriptions and consumption in the midst of a national opioid epidemic [24]. Furthermore, ORAEs are the leading causes of inhospital complications and delays in hospital
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Investigation was performed at Penn Presbyterian Medical Center, University of Pennsylvania, Philadelphia, PA.
One or more of the authors of this paper have disclosed potential or pertinent conflicts of interest, which may include receipt of payment, either direct or indirect, institutional support, or association with an entity in the biomedical field which may be perceived to have potential conflict of interest with this work. For full disclosure statements refer to http://dx.doi.org/10.1016/j.arth.2017.04.002.