Preoperative opioid use is associated with worse patient outcomes after Total joint arthroplasty: a systematic review and meta-analysis

BMC Musculoskeletal Disorders

Sung Hyun Kang¹  C. Allyson Jones²  C. Michael Goplen³  Thomas A. Churchill³  Lauren A. Beaupre⁴  Wesley Verbeek⁵  Donald C. Voaklander⁶ 

[1] Alberta Bone and Joint Institute, T2N 4Z6, Calgary, Alberta, Canada;grid.17089.37, Department of Physical Therapy, University of Alberta, T6G 2G4, Edmonton, AB, Canada;grid.17089.37, School of Public Health, University of Alberta, T6G 1C9, Edmonton, Alberta, Canada;grid.17089.37, Department of Surgery, University of Alberta, T6G 2B7, Edmonton, AB, Canada;grid.17089.37, Department of Surgery, University of Alberta, T6G 2B7, Edmonton, AB, Canada;grid.17089.37, Department of Physical Therapy, University of Alberta, T6G 2G4, Edmonton, AB, Canada;grid.17089.37, Faculty of Medicine and Dentistry, University of Alberta, T6G 2R7, Edmonton, AB, Canada;grid.17089.37, School of Public Health, University of Alberta, T6G 1C9, Edmonton, Alberta, Canada;

关键词: Opioids;    Total knee arthroplasty;    Total hip arthroplasty;    Patient-reported outcomes;   

DOI  :  10.1186/s12891-019-2619-8

来源: publisher

【 摘 要 】

BackgroundA significant number of patients use opioids prior to total joint arthroplasty (TJA) in North America and there is growing concern that preoperative opioid use negatively impacts postoperative patient outcomes after surgery. This systematic review and meta-analysis evaluated the current evidence investigating the influence of preoperative opioid use on postoperative patient-reported outcomes (PRO) after total joint arthroplasty.MethodsA systematic search was performed using Ovid, Embase, Cochrane Library, Scopus, Web of Science Core Collection, CINAHL on February 15th, 2018. Studies reporting baseline and postoperative PRO among those prescribed preoperative opioids and those who were not prior to total knee and hip arthroplasty were included. Standardized mean differences (SMD) in absolute difference and relative change in PRO measures between the two groups was calculated using random effect models.ResultsSix studies were included (n = 7356 patients); overall 24% of patients were prescribed preoperative opioids. Patients with preoperative opioid use had worse absolute postoperative PRO scores when compared to those with no preoperative opioid use (standardized mean difference (SMD) -0.53, 95% Confidence interval (CI) -0.75, − 0.32, p < 0.0001). When relative change in PRO score was analyzed, as measured by difference between postoperative and preoperative PRO scores, there was no group differences (SMD -0.26, 95% CI -0.56, 0.05, p = 0.10).ConclusionPatients prescribed preoperative opioids may attain worse overall pain and function benefits after TJA when compared to opioid-naïve patients, but do still benefit from undergoing TJA. These results suggest preoperative opioid users should be judiciously counselled regarding potential postoperative pain and function improvements after TJA.

【 授权许可】

CC BY