Opioid Claims Prior to Elective Total Joint Arthroplasty and Risk of Prolonged Postoperative Opioid Claims

The United States is experiencing a national opioid epidemic. This study seeks to analyze recent trends in opioid claims after elective total joint arthroplasty and quantify the effect of preoperative opioid use on risk of prolonged postoperative claim rates.

A retrospective cohort study was conducted using the PearlDiver database to track annual trends in opioid claims after elective total hip arthroplasty (THA), total knee arthroplasty (TKA), and total shoulder arthroplasty (TSA). Trend analysis of opioid claim rates was done with the Cochran-Armitage test. Rates of postoperative opioid claims were compared between opioid-naïve patients versus patients with opioid claims in the preoperative year through multivariable logistic regression.

In total, 105,860 procedures were included. For all procedures, the proportion of patients filing an opioid claim within 30 days postoperatively trended upward from 2011 to 2017 (all P < 0.001). Patients with one to three opioid claims in the year before arthroplasty were more likely to file an opioid claim within 30 days after arthroplasty (THA: odds ratio [OR], 2.61; TKA: OR, 3.04; and TSA: OR, 4.83), between 31 and 90 days (THA: OR, 2.76; TKA: OR, 2.87; and TSA: OR, 3.22), and between 91 days and 6 months (THA: OR, 4.83; TKA: OR, 4.07; and TSA: OR, 3.77). Patients with more than three prior opioid claims were more likely to file an opioid claim within 30 days (THA: OR, 6.15; TKA: OR, 6.79; and TSA: OR, 8.68), between 31 and 90 days (THA: OR, 20.99; TKA: OR, 14.00; and TSA: OR, 28.40), and between 91 days and 6 months (THA: OR, 46.31; TKA: OR, 33.93; and TSA: OR, 59.06).

Opioid claims in the preoperative year markedly increase risk of prolonged postoperative opioid claims after arthroplasty. Surgeons should look further before the acute preoperative period when evaluating opioid exposure and assessing risk of chronic opioid dependence after elective arthroplasty.

Level III.