Predicting Post-Discharge Opioid Consumption after Total Hip and Knee Arthroplasty in the Opioid Naïve Patient.
Academic Article
Overview
abstract
BACKGROUND: Pain catastrophizing, anxiety, and depression are associated with poor outcomes after total hip (THA) and total knee (TKA) arthroplasty. The goal of this study was to determine the relationship between postoperative pain scores and opioid consumption; and the association between preoperative measures of anxiety, depression and pain catastrophizing and postoperative opioid consumption in patients undergoing THA and TKA. METHODS: This was a single-institution prospective cohort study of 243 opioid-naïve patients undergoing elective, primary THA (n=123) or TKA (n=120) for osteoarthritis. Preoperatively patients completed the PROMIS-29 (Physical-Function/Anxiety/Depression/Fatigue/Sleep-Disturbance/Social-Activities/Pain-Interference/Pain-Intensity) and Pain Catastrophizing Scale (PCS). Postoperatively patients completed a weekly survey for 12 weeks determining morphine-milligram-equivalent (MME) opioid consumption, opioid cessation, and visual-analog-scale pain scores. Multivariable regression models determined the association between preoperative scores and postoperative opioid consumption. RESULTS: Mean(± standard-deviation) total opioid consumption and duration was 75.1±112.0 MME and 1.7±1.7 weeks in THA and 384.7±473.3 MME and 4.3±3.5 weeks in TKA. Visual-analog-scale pain scores (0-100) after opioid cessation were 28.0±22.9 in THA and 30.7±25.8 in TKA. Multivariable regression showed that each unit increase in PROMIS-29 Fatigue-T-Score was associated with 8.4 hours longer opioid usage in THA (p=0.008) and 15.1 hours longer in TKA (p=0.036), as well as 12.7 MME additional opioids in TKA (p=0.027). There were no significant associations with other PROMIS-29 domains or the PCS. CONCLUSION: Opioid use duration is different for THA and TKA and may correlate with pain scores. Only preoperative fatigue was associated with postoperative opioid consumption. These findings should inform THA and TKA postoperative pain management pathways.
