Details

Autor(en) / Beteiligte

• Rozell, Joshua C., MD
• Courtney, P. Maxwell, MD
• Dattilo, Jonathan R., MD
• Wu, Chia H., MD, MBA
• Lee, Gwo-Chin, MD

Titel

Pre-Operative Opiate Use Independently Predicts Narcotic Consumption and Complications Following Total Joint Arthroplasty

Ist Teil von

• The Journal of arthroplasty, 2017

Erscheinungsjahr

2017

Link zum Volltext

Quelle

Alma/SFX Local Collection

Beschreibungen/Notizen

• Abstract Background Multimodal pain protocols have reduced opioid requirements and decreased complications following elective total hip (THA) and total knee (TKA) arthroplasty. However, these protocols are not universally effective. The purposes of this study are to determine the risk factors associated with increased opioid requirements and the impact of preoperative narcotic use on length of stay and in-hospital complications following THA/TKA. Patients and Methods We prospectively evaluated a consecutive series of 802 patients undergoing elective primary THA and TKA over a 9-month period. All patients were managed using a multimodal pain protocol. Data on medical comorbidities and history of preoperative narcotic use were collected and correlated with deviations from the protocol. Results Of the 802 patients, 266 (33%) required intravenous (IV) narcotic rescue. Patients younger than age 75 (Odds Ratio (OR) 1.85, 95% Confidence Interval (CI) 1.10-3.12, p=0.019) and with preoperative narcotic use (OR 2.74, 95% CI 2.01-3.75, p<0.001) were more likely to require rescue. Multivariate logistic regression demonstrated that preoperative narcotic use (OR 2.74, 95% CI 2.01-3.75, p<0.001) was the largest independent predictor of increased postoperative opioid requirements. These patients developed more in-hospital complications (OR 1.92, 95% CI 1.34-2.76, p<0.001). This was associated with increased length of stay (OR 1.59, 95% CI 1.06-2.37, p=0.025) and a 2.5 times risk of requiring oral narcotics at 3 months postoperatively (OR 2.48, 95% CI 1.61-3.82, p<0.001). Conclusion Despite the effectiveness of multimodal postoperative pain protocols, younger patients with preoperative history of narcotic use require additional opioids and are at higher risk for complications and greater length of stay.