Vol.:(0123456789) 1 3 European Journal of Orthopaedic Surgery & Traumatology https://doi.org/10.1007/s00590-019-02618-w ORIGINAL ARTICLE Risk factors associated with persistent chronic opioid use following THA Afshin A. Anoushiravani 1  · Kelvin Y. Kim 2  · Mackenzie Roof 2  · Kevin Chen 2  · Casey M. O’Connor 1  · Jonathan Vigdorchik 2  · Ran Schwarzkopf 2 Received: 27 June 2019 / Accepted: 19 December 2019 © Springer-Verlag France SAS, part of Springer Nature 2020 Abstract Introduction An understanding of patient characteristics associated with persistent chronic opioid use after total joint arthro- plasty (TJA) will allow surgeons to better manage these patients. Our study aims to identify risk factors among preoperative chronic opioid users who continue to chronically use narcotics after total hip arthroplasty (THA). Methods A retrospective analysis was performed on 256 THA recipients using the state’s mandated opioid monitoring program to identify preoperative chronic opioid users. Chronic users were stratifed into two cohorts based on their use 6 months after surgery: (1) persistent chronic and (2) previous chronic users. Patient demographics and relevant histories were abstracted and comparatively assessed between the cohorts. In addition, an analysis was performed to calculate which preoperative opioid dose was most predictive of chronic use. Results Within the study population, 54 patients were identifed as preoperative chronic opioid users. Of them, 13 (24.1%) were identifed as persistent chronic users 6 months following surgery. Specifc characteristics associated with a higher like- lihood of persistent chronic opioid use included: male gender, ASA score > 2, and Medicare as a payer type. A 33 mg/day morphine-equivalent dose consumption prior to surgery was most predictive for persistent chronic opioid use. Conclusion Our study demonstrates that patients who are male, have an ASA > 2, and use Medicare are at greater risk of persistent chronic opioid use. Thus, given the poor outcomes associated with chronic opioid use, these fndings may help guide surgeons’ clinical decision-making process when encountering patients with a history of opioid use. Keywords Total hip arthroplasty · Narcotics · Chronic opioid use · Pain control · Patient outcomes Introduction Medical comorbidities have long been associated with sub- optimal outcomes following total joint arthroplasty (TJA). These comorbidities often include increased age, inadequate nutrition, and poorly managed chronic diseases [5]. As such, healthcare organizations are making eforts to preoperatively identify and optimize modifable risk factors with the goal of enhancing the quality of care the patient receives [19]. One modifable risk factor for particular concern is perioperative opioid abuse. Opioids are a class of medication that bind the mu-opioid pain receptor and are typically prescribed for pain relief. Historically opioids were designed to treat pain in cancer patients, not pain from osteoarthritis. The adoption of “pain as the ffth vital sign” following recommendations of the Joint Commission in 2001 led to the widespread use of opioids to treat other causes of pain and is viewed by many as the inception of the opioid crisis [6, 7, 15]. During the same time period, the Centers for Disease Control and Prevention (CDC) estimated that prescription drug abuse is the fastest growing premature cause of death in the USA, resulting in over 33,000 deaths, a fvefold increase since 2001 (Parthvi et al.; [Centers for Disease Control and Pre- vention [3] 2012]). In addition to their addictive and lethal properties, perio- perative chronic opioid use may also be an independent risk factor for poor surgical outcomes (Zywiel et al.; [23, 25, 29]). Zarling and colleagues reported that TJA recipients consuming a greater amount of preoperative medications, * Afshin A. Anoushiravani afshin.anoushiravani@gmail.com 1 Department of Orthopaedic Surgery, Albany Medical Center, 43 New Scotland, Albany, NY 12208, USA 2 Department of Orthopaedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York City, USA