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Preoperative Opioid Use Negatively Affects Patient-reported Outcomes After Primary Total Hip Arthroplasty

Bonner, Bryant E. MD; Castillo, Tiffany N. MD; Fitz, David W. MD; Zhao, John Z. MD; Klemt, Christian PhD; Kwon, Young-Min MD, PhD

JAAOS - Journal of the American Academy of Orthopaedic Surgeons: November 15, 2019 - Volume 27 - Issue 22 - p e1016-e1020
doi: 10.5435/JAAOS-D-18-00658
Research Article
SDC

Background: Opioid use is a public health crisis in the United States and an area of increased focus in orthopaedic surgery. The aim of this study is to investigate whether preoperative opioid use had any effect on patient-reported outcome measures (PROMs) before and after total hip arthroplasty (THA).

Methods: A total of 389 patients with THA with both preoperative and postoperative PROMs were reviewed: (1) 76 patients with preoperative opioid use (24%) and (2) 237 patients without preoperative opioid use (76%). Patient demographics and clinical information including opioid use, length of stay, and implant information.

Results: Preoperative opioid users were more likely to stay in the hospital longer (P = 0.004) and be discharged to a rehabilitation facility (P = 0.038). Postoperatively, the Physical Function Short Form 10a (P = 0.021) and Patient-Reported Outcomes Measurement Information System Global-10 (P < 0.001 physical, P = 0.001, mental) were significantly lower in the preoperative opioid users. Within groups, both nonusers and preoperative opioid users saw improvements after THA in Hip Disability and Osteoarthritis Outcome Score-Physical Function Short Form (P < 0.001), Short Form 10a (P < 0.001), and Patient-Reported Outcomes Measurement Information System Global-10 (P < 0.001, physical and P = 0.008, mental).

Discussion: Although all patients reported improvements after THA regardless of preoperative opioid use, preoperative opioid users undergoing THA had significantly lower patient-reported outcome scores, longer hospital stays, and a more likely discharge to rehabilitation.

From the Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA.

Correspondence to Dr. Kwon: ymkwon@mgh.harvard.edu

None of the following authors or any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Bonner, Dr. Castillo, Dr. Fitz, Dr. Zhao, Dr. Klemt, and Dr. Kwon.

This study received financial support from the Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School.

Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (www.jaaos.org).

Copyright 2019 by the American Academy of Orthopaedic Surgeons.
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