The use of Opioids in Total Knee Arthroplasty Patient: Main Characteristics, Risk Factors and Adverse Events

Abstract

Opioids are frequently used for the treatment of preoperative and postoperative pain among patients undergoing total knee arthroplasty (TKA). The greatest risk for prolonged opioid use after TKA is preoperative opioid use. Despite the effectiveness of multimodal postoperative pain protocols, younger patients with preoperative history of narcotic use require additional opioids and are at a higher risk for complications and a greater length of stay. At 90 days, respiratory complications were the most common opioid-related adverse events (TKA: 6%; RTKA: 8%), followed by postoperative nausea and vomiting (TKA: 3%; RTKA: 4%), and urinary retention complications (TKA: 3%; RTKA: 3%). For TKA, risk factors for respiratory complications included older age, lower socioeconomic status, more comorbidities, obesity, chronic obstructive pulmonary disease, white race, and patients in the Midwest and West (vs. South). The average Medicare payment for treating complications within 90 days of a TKA was $6206 and $6222 following RTKA. Avoidance or weaning of preoperative opioids should be considered.