Does Traumatic Brain Injury Increase Opioid Utilization After Primary Total Knee Arthroplasty?

Area of Science:

• Neurology
• Orthopedic Surgery
• Pain Management

Background:

• Traumatic brain injury (TBI) is a significant neurological event linked to increased pain and opioid dependence.
• Understanding the impact of TBI on post-surgical pain management is crucial for optimizing patient outcomes.

Purpose of the Study:

• To evaluate the effect of a prior traumatic brain injury (TBI) on perioperative opioid consumption.
• To assess the risk of prolonged opioid usage in patients undergoing total knee arthroplasty (TKA) with a history of TBI.

Main Methods:

• A large administrative claims database was utilized, identifying TKA patients from 2010-2022.
• Patients were stratified into cohorts based on prior TBI diagnosis (n=127,369) versus no TBI (n=1,116,605).
• Perioperative opioid utilization and persistent opioid usage (90-180 days post-surgery) were primary and secondary outcomes, analyzed via multivariate regression.

Main Results:

• The TBI cohort exhibited significantly higher perioperative opioid utilization (987.5 MME) compared to the control group (896.7 MME).
• Persistent opioid usage was more prevalent in the TBI cohort (17.5%) versus the control group (14.5%).
• A prior TBI diagnosis within one year of TKA significantly increased the risk of persistent opioid usage (OR 1.20).

Conclusions:

• A history of traumatic brain injury (TBI) is associated with increased perioperative opioid use following total knee arthroplasty (TKA).
• Patients with prior TBI face a higher likelihood of prolonged opioid utilization post-TKA.
• Further investigation into the underlying mechanisms is warranted to develop targeted interventions for this patient group.