The purpose of this study was to identify the preoperative daily opioid dose associated with increased complications after primary THA.
Primary THA patients in the Humana claims database (2007-2020) with an opioid prescription within three months prior to surgery were identified. Patients were stratified based on daily opioid dose: Tier 1) 50 MME. Each tier was matched 1:1 to opioid naïve patients. Emergency department (ED) visits, readmissions, and postoperative complications were compared.
67,719 Patients using preoperative opioids were identified and matched. 17.0% of patients using preoperative opioids visited the ED within 90 days, compared to 13.3% of opioid naïve patients (p<.001). 9.5% of patients using preoperative opioids were readmitted within 90 days, compared to 7.4% of opioid naïve patients (p<.001). When stratified by tier, opioid users in all tiers had higher risk of ED visits and readmission. Rates of superficial infection, periprosthetic joint infection (PJI), and dislocation were increased in patients taking preoperative opioids in Tiers 2 through 5. Patients in Tiers 3 through 5 had an increased risk of revision surgery.
Preoperative opioid use is associated with a dose-dependent increase in complications after THA. Just one 5mg hydrocodone tablet daily leads to a significant increase in ED visits and readmission, while higher doses are associated with dislocation, superficial infection, PJI, and revision surgery. Continued education regarding the harmful effects of opioids prescribed for the non-operative treatment of osteoarthritis is still needed.

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