Opioid Consumption Patterns Before and After Elective Joint Surgery

Opioid use is associated with multiple risks, including accidental overdose and addiction. Total knee arthroplasty (TKA) and total hip arthroplasty are among the most common elective procedures. The goal of surgery is to relieve patients of their joint pain and reduce dependence on analgesics, but these procedures can result in chronic opioid use.

This retrospective analysis occurred at Kaiser Permanente Washington between March 2018 and May 2023. A preoperative opioid user was defined as a patient who had filled two or more opioid prescriptions in the 3-month preoperative period. A Chi-square test was used to evaluate the relationship between preoperative opioid use and continued use of opioids 10 to 12 months postoperatively.

Of 8,886 patients who underwent a TKA or total hip arthroplasty, 24% were considered preoperative opioid users. The average age was 68 years, and 59% of patients were women. Over the study period, the total number of opioid prescriptions filled was 43,326. At 10 to 12 months postoperatively, 39% of preoperative opioid users continued using opioids compared with 9% of nonchronic opioid users (P < 0.05). Exploratory analysis showed factors associated with a higher likelihood of persistent opioid use 10 to 12 months postoperatively include women and undergoing a TKA procedure.

Understanding opioid utilization after total joint arthroplasty is essential to identifying strategies to minimize overprescribing and promote rational opioid use. Approximately 39% of preoperative opioid users and 9% of nonchronic opioid users continued use of opioids for 10 to 12 months after surgery. Specific patient characteristics were associated with the development of persistent postoperative opioid use. Although this study did not include multivariate analysis, which limits the conclusions we can draw from this data, the magnitude of the trends noted is large enough to warrant further studies.