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      Effect of Preoperative Opioid Use on Adverse Outcomes, Medical Spending, and Persistent Opioid Use Following Elective Total Joint Arthroplasty in the United States: A Large Retrospective Cohort Study of Administrative Claims Data

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          Abstract

          Objective

          Between 17% and 40% of patients undergoing elective arthroplasty are preoperative opioid users. This US study analyzed patients in this population to illustrate the relationship between preoperative opioid use and adverse surgical outcomes.

          Design

          Retrospective study of administrative medical and pharmaceutical claims data.

          Subjects

          Adults (aged 18+) who received elective total knee, hip, or shoulder replacement in 2014–2015.

          Methods

          A patient was a preoperative opioid user if opioid prescription fills occurred in two periods: 1–30 and 31–90 days presurgery. Zero-truncated Poisson (incidence rate ratio [IRR]), logistic (odds ratio [OR]), Cox (hazard ratio [HR]), and quantile regressions modeled the effects of preoperative opioid use and opioid dose, adjusted for demographics, comorbidities, and utilization.

          Results

          Among 34,792 patients (38% hip, 58% knee, 4% shoulder), 6,043 (17.4%) were preoperative opioid users with a median morphine equivalent daily dose of 32 mg. Preoperative opioid users had increased length of stay (IRR = 1.03, 95% CI = 1.02 to 1.05), nonhome discharge (OR = 1.10, 95% CI = 1.00 to 1.21), and 30-day unplanned readmission (OR = 1.43, 95% CI = 1.17 to 1.74); experienced 35% higher surgical site infection (HR = 1.35, 95% CI = 1.14 to 1.59) and 44% higher surgical revision (HR = 1.44, 95% CI = 1.21 to 1.71); had a median $1,084 (95% CI = $833 to $1334) increase in medical spend during the 365 days after discharge; and had a 64% lower rate of opioid cessation (HR = 0.34, 95% CI = 0.33 to 0.35) compared with patients not filling two or more prescriptions across periods.

          Conclusions

          Preoperative opioid users had longer length of stay, increased revision rates, higher spend, and persistent opioid use, which worsened with dose. Adverse outcomes after elective joint replacement may be reduced if preoperative opioid risk is managed through increased monitoring or opioid cessation.

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          Most cited references26

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          Trends in Opioid Analgesic-Prescribing Rates by Specialty, U.S., 2007-2012.

          Opioid analgesic prescriptions are driving trends in drug overdoses, but little is known about prescribing patterns among medical specialties. We conducted this study to examine the opioid-prescribing patterns of the medical specialties over time.
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            Pharmaceutical overdose deaths, United States, 2010.

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              Assessing the Sensitivity of Regression Results to Unmeasured Confounders in Observational Studies

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                Author and article information

                Journal
                Pain Med
                Pain Med
                painmedicine
                Pain Medicine: The Official Journal of the American Academy of Pain Medicine
                Oxford University Press
                1526-2375
                1526-4637
                March 2020
                23 May 2019
                23 May 2019
                : 21
                : 3
                : 521-531
                Affiliations
                [1 ] axialHealthcare Inc , Nashville, Tennessee
                [2 ] Department of Biostatistics, Vanderbilt University Medical Center , Nashville, Tennessee
                [3 ] Department of Anesthesiology, Perioperative and Pain Medicine , Brigham and Women’s Hospital, Boston, Massachusetts, USA
                Author notes
                Correspondence to: Meridith Blevins Peratikos, MS, axialHealthcare Inc, 209 10th Ave S, Suite 332, Nashville, TN 37203, USA. Tel: 615-345-3568; Fax: 615-540-1044; E-mail: mperatikos@ 123456axialhealthcare.com .
                Author information
                http://orcid.org/0000-0002-3861-9859
                Article
                pnz083
                10.1093/pm/pnz083
                7060398
                31120529
                084e4763-4e93-4c9d-87ec-0666f687bf62
                © 2019 American Academy of Pain Medicine.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License( http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contactjournals.permissions@oup.com

                History
                Page count
                Pages: 11
                Funding
                Funded by: axialHealthcare;
                Categories
                Opioids & Substance use Disorders Section
                Original Research Articles

                Anesthesiology & Pain management
                arthroplasty,surgery,opioid,length of stay,costs,health outcomes,readmission,surgical revision,surgical site infection

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