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A Risk Calculator Using Preoperative Opioids for Prediction of Total Knee Revision Arthroplasty
Jordan Starr1, Irene Rozet1, Alon Ben-Ari2
1Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA.
The Clinical Journal of Pain
|September 16, 2017
Summary
Chronic opioid use before total knee arthroplasty (TKA) increases the risk of total knee revision (TKR). A new risk calculator predicts TKR, aiding in patient management.
Area of Science:
- Orthopedic Surgery
- Health Informatics
- Pain Management
Background:
- Total knee arthroplasty (TKA) aims to enhance patient quality of life.
- A subset of patients require early total knee revision (TKR) after initial TKA.
- Preoperative chronic opioid use is a known risk factor for TKR, yet no predictive tool exists.
Purpose of the Study:
- To develop and validate a risk calculator for predicting early total knee revision (TKR) after total knee arthroplasty (TKA).
- To identify key predictors of TKR, including chronic opioid use.
Main Methods:
- Retrospective analysis of 32,297 Veterans Affairs patients undergoing TKA between 2006 and 2012.
- Development of a cross-validated Cox proportional hazards model to predict TKR.
- Evaluation of model performance using mean absolute error at 1 and 5 years.
Main Results:
- Chronic opioid use was a significant predictor of TKR (HR, 1.27; P<0.001).
- Other significant predictors included age, female sex, body mass index, diabetes, and chronic kidney disease.
- The generated risk calculator demonstrated a mean absolute error of 0.1% at 1 year and 3.6% at 5 years.
Conclusions:
- Preoperative chronic opioid use is a significant risk factor for total knee revision (TKR).
- A validated risk calculator incorporating opioid use and other factors has been developed to predict TKR.
- This tool can aid clinicians in managing patients undergoing total knee arthroplasty (TKA).
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