Vakharia RM, Sabeh KG, Vakharia AM, Damodar DM, Law TY, Roche MW. Comparison of implant related complications amongst patients with opioid use disorder and non-users following total knee arthroplasty. World J Orthop 2019; 10(3): 137-144 [PMID: 30918797 DOI: 10.5312/wjo.v10.i3.137]
Corresponding Author of This Article
Rushabh M Vakharia, MD, Research Fellow, Department of Orthopedic Surgery, Holy Cross Orthopedic Institute, 5597 North Dixie Highway, Fort Lauderdale, FL33308, United States. rush.vakharia@gmail.com
Research Domain of This Article
Orthopedics
Article-Type of This Article
Retrospective Study
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
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Vakharia RM, Sabeh KG, Vakharia AM, Damodar DM, Law TY, Roche MW. Comparison of implant related complications amongst patients with opioid use disorder and non-users following total knee arthroplasty. World J Orthop 2019; 10(3): 137-144 [PMID: 30918797 DOI: 10.5312/wjo.v10.i3.137]
World J Orthop. Mar 18, 2019; 10(3): 137-144 Published online Mar 18, 2019. doi: 10.5312/wjo.v10.i3.137
Comparison of implant related complications amongst patients with opioid use disorder and non-users following total knee arthroplasty
Rushabh M Vakharia, Karim G Sabeh, Ajit M Vakharia, Dhanur M Damodar, Tsun Yee Law, Martin W Roche
Rushabh M Vakharia, Tsun Yee Law, Martin W Roche, Department of Orthopedic Surgery, Holy Cross Orthopedic Institute, Fort Lauderdale, FL 33334, United States
Karim G Sabeh, Department of Orthopedic Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, United States
Ajit M Vakharia, Department of Medicine, Morehouse School of Medicine, Atlanta, GA 30310, United States
Dhanur M Damodar, Department of Orthopedic Surgery, University of Miami Hospital, Miami, FL 33135, United States
Author contributions: Vakharia RM, Sabeh KG, Vakharia AM, Damodar D, Law TY and Roche WM contributed significantly towards project design, analysis, and manuscript writing and editing.
Institutional review board statement: This study has been determined exempt from Institutional Review Board (IRB) review by the Holy Cross Hospital Research Office.
Informed consent statement: As this study utilizes publicly available data from a nationwide database, informed consent was not obtained from individual subjects included in the study. Study data contained no patient identifiers and cannot be linked to an individual patient.
Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Rushabh M Vakharia, MD, Research Fellow, Department of Orthopedic Surgery, Holy Cross Orthopedic Institute, 5597 North Dixie Highway, Fort Lauderdale, FL33308, United States. rush.vakharia@gmail.com
Telephone: +1-954-4894579 Fax: +1-954-2298698
Received: August 16, 2018 Peer-review started: August 17, 2018 First decision: October 4, 2018 Revised: December 13, 2018 Accepted: January 9, 2019 Article in press: January 9, 2019 Published online: March 18, 2019 Processing time: 204 Days and 10.6 Hours
Abstract
BACKGROUND
The influence of opioid use disorder on implant related complications, infection and readmission rates, and total global episode-of-care costs following primary total knee arthroplasty (TKA) is limited.
AIM
To examine whether opioid abuse in patients undergoing primary TKA.
METHODS
A retrospective analysis of the Medicare dataset, using the PearlDiver database, from 2005-2014 comparing outcomes in patients with opioid abusers (OUD) to non-opioid abusers (NOU) undergoing primary TKA was performed. Patient outcomes were analyzed including implant complications, readmission rates, and day-of-surgery and 90-d cost. Statistical analysis was performed with R (University of Auckland, New Zealand) calculating odds-ratio (OR) along with their respective 95% confidence interval (95%CI) and P-values.
RESULTS
The OUD group was at greater odds of having implant related complications overall (20.84% vs 11.25%; OR: 2.07; 95%CI: 1.93-2.23; P < 0.001). Revision (OR: 2.07; 95%CI: 1.11-3.84; P < 0.001), infection (OR: 1.92; 95%CI: 1.72–2.18; P < 0.001), periprosthetic fractures (OR: 1.83; 95%CI: 1.16-4.79; P < 0.001), and 90-d readmission rates (OR: 1.47, 95%CI: 1.35-1.61, P < 0.001) were also significantly increased. OUD patients also incurred in higher day-of-surgery and total global 90-d episode-of-care costs compared to NOU.
CONCLUSION
Patients with OUD show an increased risk of complications compared to the non-opioid users group. Appropriate recognition, pre-surgical optimization, and patient education are essential to mitigate these complications and improve patient outcome.
Core tip: A retrospective analysis of the Medicare database demonstrated that patients with opioid dependence or abuse diagnosis had higher rates of implant related complications, 90-d readmission rates, and cost of care in patients undergoing primary total knee arthroplasty.
