Preoperative and Postoperative Opiate Use by the Arthroplasty Patient

As opioid use increases nationally, the arthroplasty surgeon is likely to see more patients taking opioid analgesics on initial presentation. The purpose of this study was to investigate the use of opiate medication in the preoperative and postoperative patient undergoing primary total joint arthroplasty.

From October 2010 to November 2011, data on 367 consecutive patients who underwent primary total joint arthroplasty were reviewed. Using the Michigan Automated Prescription System database, data were collected on opiate use from 3 months preop to 12 months postop. Patients were grouped by preoperative opiate use. Patients with ≥2 opiate prescriptions filled per 6-week period before surgery were considered chronic opiate users.

Three hundred fifteen patients fit our inclusion/exclusion criteria. There were 158 primary total knee and 157 primary total hip arthroplasty patients. At 1 year after operation, 64% of chronic opiate users were still being prescribed opiates compared with 22% of the control group (P < .001). Thirty-one percent of the chronic opiate users were discharged to an extended care facility compared to 21% of the control group (P = .123). Of all the opiate prescriptions, 77% were written by a practitioner other than the surgeon.

Opiates are frequently prescribed by providers other than the surgeon preoperatively and postoperatively. The use of opiates that were presumably prescribed to treat joint pain was continued for more than 1 year postoperatively in 64% of cases. Patients taking multiple opiates or more potent opiates preoperatively filled more prescriptions postoperatively. Chronic use of opiates negatively influenced the discharge disposition.