The Association of Preoperative Opioid Use With Revision Surgery and Complications Following Carpometacarpal Arthroplasty.

Document Type

Article

Publication Date

11-1-2021

Publication Title

Journal of Hand Surgery American

Abstract

PURPOSE: Preoperative opioid use has been shown to be associated with poor outcomes following different upper-extremity surgeries. We aimed to examine the relationship between preoperative opioid use and outcomes following carpometacarpal (CMC) arthroplasty. We hypothesized that patients prescribed higher daily average numbers of preoperative oral morphine equivalents (OMEs) would show higher rates of complications and revision surgery.

METHODS: In the Truven Health MarketScan Database, we identified all patients who underwent CMC arthroplasty from 2009 to 2018. We separated them into cohorts based on average daily OMEs prescribed in the 6 months prior to the surgery: opioid naïve,10 OMEs per day. We retrieved 90-day complications and 3-year revision surgery data, and we compared these outcomes by opioid-use groups.

RESULTS: We identified 40,141 patients. The majority (55.9%) were opioid naïve, with the next most common group receiving a daily average of10 OMEs per day had a 1.45% increase in 3-year revision surgery compared with opioid-naïve patients, which equated to 2.12 (confidence interval [CI]: 1.33-3.36) times increased odds. Additionally, patients taking >10 OMEs had increased odds of an emergency department visit (odds ratio [OR]: 1.60, CI: 1.43-1.78), a 90-day hospital admission (OR: 2.34, CI: 1.97-2.79), and surgical site infection (OR, 2.02, CI: 1.59-2.54) compared with opioid-naïve patients, with absolute differences of 4.53%, 2.78%, and 1.22% compared with opioid-naïve patients, respectively. Additionally, preoperative opioid use predicted both number of prescriptions filled in the short term and long term continued opioid use.

CONCLUSIONS: Preoperative opioid use of >10 OMEs per day is associated with a higher risk for complications and revision surgery following CMC arthroplasty. Our findings demonstrate a dose-dependent relationship between opioid use and postoperative complications. Further study is necessary to determine if reducing opioid use prior to CMC arthroplasty may reduce the likelihood of these negative outcomes.

TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic II.

Volume

46

Issue

11

First Page

1

Last Page

1025

DOI

10.1016/j.jhsa.2021.02.021

ISSN

1531-6564

PubMed ID

33875281

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