Surgical Approach Does Not Affect Chronic Opioid Usage After Total Hip Arthroplasty
Weston Gentry1, Jeffrey B Stambough1, Austin Porter2
1Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
Insights
Pre-existing opioid use, not the surgical approach for total hip arthroplasty (THA), predicts long-term opioid consumption. Patients not using opioids before surgery had significantly lower odds of becoming chronic users post-THA.
Area of Science:
- Orthopedic Surgery
- Pain Management
- Pharmacology
Background:
- Total hip arthroplasty (THA) utilizes direct anterior, antero-lateral, and posterior surgical approaches.
- The direct anterior approach is theorized to reduce postoperative pain and opioid use.
- Perioperative opioid consumption is a risk factor for long-term opioid dependence.
Purpose of the Study:
- To investigate if the direct anterior approach for THA is associated with reduced opioid usage within 180 days compared to antero-lateral or posterior approaches.
- To evaluate the association between THA surgical approach and long-term opioid use.
Main Methods:
- Retrospective cohort study of 508 patients undergoing THA.
- Opioid use assessed 90 days pre-surgery and 1 year post-surgery using state prescription data.
- Regression analyses controlled for patient demographics and surgical characteristics to assess the impact of surgical approach on opioid use.
Main Results:
- No significant difference in long-term opioid use or prescription fills was observed among the three surgical approaches (P = .78 and P = .35, respectively).
- Pre-operative opioid non-use was strongly associated with a 78% decrease in the odds of becoming a chronic opioid user post-THA (P < .0001).
Conclusions:
- Pre-operative opioid use, rather than the specific THA surgical approach, is the primary predictor of chronic opioid consumption after total hip arthroplasty.
- Screening for and managing pre-existing opioid use may be crucial for mitigating long-term opioid dependence following THA.
Background:
Three different surgical approaches (the direct anterior, antero-lateral, and posterior) are commonly used for total hip arthroplasty (THA). Due to an internervous and intermuscular approach, the direct anterior approach may result in less postoperative pain and opioid use, although all 3 approaches have similar outcomes 5 years after surgery. Perioperative opioid medication consumption poses a dose-dependent risk of long-term opioid use. We hypothesized that the direct anterior approach is associated with less opioid usage over 180 days after surgery than the antero-lateral or posterior approaches.
Methods:
A retrospective cohort study was performed including 508 patients (192 direct anterior, 207 antero-lateral, and 109 posterior approaches). Patient demographics and surgical characteristics were identified from the medical records. The state prescription database was used to determine opioid use 90 days before and 1 year after THA. Regression analyses controlling for sex, race, age, and body mass index were used to determine the effect of surgical approach on opioid use over 180 days after surgery.
Results:
No difference was seen in the proportion of long-term opioid users based on approach (P = .78). There was no significant difference in the distribution of opioid prescriptions filled between surgical approach groups in the year after surgery (P = .35). Not taking opioids 90 days prior to surgery, regardless of approach, was associated with a 78% decrease in the odds of becoming a chronic opioid user (P < .0001).
Conclusion:
Opioid use prior to surgery, rather than THA surgical approach, was associated with chronic opioid consumption following THA.
Related Concept Videos
01:15Opioid Analgesics: Synthetic and Semisynthetic Opioids
01:23Peripheral Artery Disease V: Postoperative Nursing Management
01:25Analgesia and Pain Management
01:20Opioid Analgesics: Morphine and Other Natural Cogeners
01:26Endoscopic Procedures IV: Sigmoidoscopy and Laproscopy
Sigmoidoscopy
Sigmoidoscopy is a diagnostic procedure that uses a flexible sigmoidoscope equipped with a light source and camera to examine the rectum and sigmoid colon. The procedure involves inserting the tube through the anus...