Opioid Use and Total Joint Replacement
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SURGERY AND PERIOPERATIVE CARE (S GOODMAN, SECTION EDITOR)
Opioid Use and Total Joint Replacement Cade Shadbolt 1 & Chris Schilling 1 & Maria C. Inacio 3,4 & J. Haxby Abbott 5 & Yana Pryymachenko 5 & Ross Wilson 5 & Peter F. M. Choong 1,2 & Michelle M. Dowsey 1,2
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review We provide an overview of recent research into the relationship between preoperative opioid use and total joint replacement outcomes. Recent Findings Recent findings indicate that total joint replacement patients with a history of preoperative opioid use experience higher rates of infection, revision, short-term complications, and prolonged postoperative opioid use, along with fewer improvements in pain and function following surgery. These risks are particularly pronounced among chronic opioid users. While the baseline risk profiles of these patients may contribute to higher rates of adverse outcomes, it is also plausible that certain outcomes are directly impacted by opioid use through mechanisms such as opioid-induced hyperalgesia and immunosuppression. There is little available data on the efficacy of interventions that aim to mitigate these risks. Summary Well-designed clinical trials are needed to evaluate the efficacy of targeted perioperative interventions that aim to improve outcomes for this high-risk surgical population. Where such trials are not feasible, additional high-quality observational studies are necessary to further our understanding of the mechanisms underlying the relationships between opioid use and specific adverse outcomes. Keywords Total joint replacement . Surgery . Opioids . Narcotics . Complications . Surgical outcomes
Introduction Opioid prescribing has become increasingly common over the last two decades. [1, 2] The harms associated with opioid use
have reached epidemic proportions in countries like the United States, [3, 4] where approximately 170,000 people died from opioid-related overdoses between 2015 and 2019. [5] The prevalence of opioid use has been bolstered by steady
This article is part of the Topical Collection on Surgery and Perioperative Care * Michelle M. Dowsey [email protected] Cade Shadbolt [email protected]
Peter F. M. Choong [email protected] 1
Chris Schilling [email protected]
Department of Surgery, St Vincent’s Hospital, The University of Melbourne, Melbourne, Victoria, Australia
2
Maria C. Inacio [email protected]
Department of Orthopaedics, St Vincent’s Hospital, Melbourne, Fitzroy, Victoria, Australia
3
Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
4
Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
5
Centre for Musculoskeletal Outcomes Research, University of Otago, Dunedin, New Zealand
J. Haxby Abbott [email protected] Yana Pryymachenko [email protected] Ross Wilson ross.wilson@o
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