5% of Ortho Surgery Patients Become Long Term Opioid Users?

As the opioid crisis continues to rage on, more attention is being paid to the role surgeons play in unintentionally setting their patients on the road to long-term use of opioid prescriptions.

In, “New Long-Term Opioid Prescription-Filling Behavior Arising in the 15 Months After Orthopaedic Surgery,” published in The Journal of Bone and Joint Surgery on February 19, 2020, researchers investigated the risk of new long-term opioid prescription-filling behavior after orthopedic surgery.

Using data from the Virginia All-Payer Claims Database, the researchers found that 5.3% (95% CI, 5.1% to 5.5%) of those patients who had not touched opioids in the year before surgery started taking them on a long-term basis after orthopedic surgery.

The highest rates were found in patients who underwent a spinal procedure. Anterior cruciate ligament reconstruction patients had the lowest rates. In addition, these behaviors were more likely after a revision procedure than a primary one (p < 0.05). The increased complexity of the surgery was also a risk factor.

The researchers said that orthopedic surgeons need to be aware of the risk for new long-term opioid prescription-filling behavior after surgery.

In an accompanying editorial, “Does Orthopaedic Surgery Often Cause New Chronic Opioid Use?” Jacques T. YaDeau, M.D., Ph.D., wrote that this study should have an impact on the informed consent process.

“Shouldn’t patients know if many similar patients transition to chronic opioid use? It is common practice during informed consent to disclose the risks of complications such as infection or nerve damage that may occur much less frequently,” he said.

“It is incumbent on hospitals and physicians who perform high risk surgical procedures to determine the incidence of new long-term opioid use. Hospitals and physicians must then undertake measures to prevent patients from transitioning from opioid-free to opioid-dependent.”

He added that future research should focus on ways to reduce opioid doses and limit duration of use after surgery, including making changes to surgical techniques and finding alternative analgesics.