Table 2.
Preoperative opioid use.
| Study | Year | Pre-op opioid use | Opioid type | Opioid dose (OME) | Post-op opioid use |
|---|---|---|---|---|---|
| Morris et al. | 2015 | 32 (47.1) | NR | NR | NR |
| Morris et al. | 2016 | 60 (26.8) | NR | NR | NR |
| Cuff et al. | 2016 | 14 (8) | A prescription for 7.5 mg of hydrocodone and 325 mg of acetaminophen for postoperative pain management and was instructed to take 1 or 2 pills every 4 to 6 h as needed for pain during the first postoperative week | ||
| Cheah et al. | 2017 | 138 (52) | Short-acting opioids (oral hydrocodone, oxycodone, hydromorphone, or morphine) or long-acting opioids (extended release morphine, extended release oxycodone, methadone, or fentanyl patch) | Non–opioid users: 66.9 ± 41; Short-acting opioid users: 111.4 ± 127.3; Long-acting opioid users: 208.3 ± 135.3 | NR |
| Berglund et al. | 2018 | 174 (35.5) | NR | NR | Patients reporting preoperative narcotic use had a markedly higher incidence of opioid use at 1-year follow-up (29.1% versus 4.9%; OR, 8.320; 95% CI, 4.509 to 15.355; P < 0.001) and at final follow-up (35.1% versus 7.3%; OR, 6.877; 95% CI, 4.062 to 11.641; P < 0.001) compared with patients without preoperative use. |
| Grace et al. | 2018 | 47 (39.4) | Acetaminophen and hydrocodone (55.3%), tramadol (21.3%), oxycodone immediate release (IR) (12.8%), acetaminophen and oxycodone (8.5%), oxycodone extended release (6.4%), acetaminophen and codeine (4.3%), methadone (4.3%), morphine extended release (4.3%), and hydromorphone (2.1%) | Opioid users were found to have significantly higher opioid requirements on the first postoperative day (60 OMEs vs 45 OMEs, P = 0.01) and the day prior to discharge (42 OMEs vs 15 OMEs, P < 0.001) than non-opioid users. | A significantly higher percentage of opioid users still required opioids 6 weeks after surgery, when compared with non-opioid users (71.0% vs 9.1%, P < 0.001) |
| Menendez et al. | 2018 | 68 (16.4) | NR | NR | Patients with severe pain after surgery took more opioids (202 vs. 84 mg OMEs, P < 0.001; daily average: 73 vs. 42 mg OMEs, P < 0.001). |
| Rao et al. | 2018 | 3182 (75%) | The most common opioid type prescribed was oxycodone (37%), followed by morphine (18%) and hydromorphone. | NR | Postoperatively, 92.6% used opioids in the early recovery period, and 38% to 42% used opioids in the later rehabilitation period |
| Thompson et al. | 2019 | 26 (35.6) | NR | NR | NR |
| Brock et al. | 2019 | 3992 (17.7) | NR | NR | 1723 patients continued to have postoperative opioid use. Continuous chronic preoperative opioid use was the most significant risk factor for chronic postoperative use (odds ratio (OR) 4.84 to 39.75 for >6 M group, depending on the procedure). |
| Curtis et al. | 2019 | 50 (36.2) | Tramadol only 7 (7.95), Tramadol and an additional opioid 4 (8), Narcotic 50 (36.23), Oxycodone 15 (30), Hydrocodone 33 (66), Morphine 3 (6), Hydromorphone 1 (2), Fentanyl 1 (2). | NR | Patients using opioids for pain management preoperatively were 4.7 times as likely to be on an opioid at 3 months postarthroplasty (confidence interval, 1.96 to 11.29; P = 0.001). |
| Mayer et al. | 2019 | 27 (17.7) | NR | During the global postoperative period, chronic preoperative narcotic users had significantly higher cumulative OME compared to nonusers as inpatients and at 2 wk, 6 wk, and 12 wk (3209 Vs 1814; P = 0.003). | NR |
| Williams et al. | 2019 | 44 (22.0) | NR | NR | On average (log-transformed), patients in the preoperative opioid group received 1.91 (95% confidence interval, 1.31–2.78) times more opioids over a postoperative course of treatment that was 2.73 (95% confidence interval, 1.62–4.59) times longer than patients who did not take opioids preoperatively |
| Khazi et al. | 2019 | 1812 (37.7) | NR | NR | After the first postoperative month, patients in the preoperative opioid group had a significantly higher opioid prescription fill rate than patients in the N-OU group (P < 0.0001, Table 2) |
| Kolade et al. | 2020 | 122 (20) | NR | 47.4 (65.7) | Preoperative opioid use was correlated with higher inpatient opioid after TSA. Patients who received opioid prescriptions prior to surgery had 43% higher opioid consumption on average in the immediate postoperative period (P = 0.0013). The cohort of patients with preoperative opioid use had an average of 38.8 MMEs compared with 27.1 MMEs in the cohort of patients without a history of preoperative opioid use |
| Best et al. | 2020 | 1571 (28) | Hydrocodone Short Acting 939 (60); Oxycodone Short Acting 386 (25); Codeine 54 (3.4); Oxycodone Long Acting 46 (2.9); Fentanyl Long Acting 31 (2.0); Hydromorphone Short Acting 27 (1.7); Morphine Long Acting 23 (1.5); Other 65 (4.1) | Oxycodone Short Acting 112 ± 261; Hydrocodone Short Acting 92 ± 116 | Postoperative opioid use was found in 4424 (79) |
| Sabesan et al. | 2020 | In the primary arthroplasty cohort 19.5% patients were preoperatively dependent compared to 38.8% in the revision cohort. | NR | Mean preoperative TMEs of 115.2 (±245.6) for the revision arthroplasty group compared to the primary arthroplasty group (mean TMEs 31.5 ± 54.8). For the preoperatively naïve patients, the results were significantly lower, at 86.5 TMEs in the primary group and 115.1 for the revision group. | Postoperatively the revision group had significantly higher rates of postoperative dependence at 43.8% compared to 29.3% patients in the primary group. The OR for the type of surgery decreased after being adjusted for confounders, and its association with the outcome remained non-significant (Adjusted Odd Ratio (aOR) 1.27, 95%CI 0.59–1.74, P = 0.54). Preoperative dependence (aOR 6.44, 95%CI 2.89–14.4, P < 0.0001) was independently associated with postoperative opioid dependence ater adjustment. |
| Jildeh et al. | 2020 | Acute user 19 (5.6); Chronic user 32 (9.4); total 51 (15) | NR | NR | On average, chronic users filled 2.61 ± 3.53 prescription refills, acute opioid users filled 1.63 ± 2.09 prescription refills, and non-opioid users filled 0.57 ± 1.14 prescription refills. |
| Peratikos et al. | 2020 | 318 (23) | NR | from 0 to 100 | 45 days post op 1243 (90); 18 months post op 322 (23) |
| Lu et al. | 2020 | 184 | Hydrocodone 214 (86.6), Oxycodone 9 (3.6), Hydromorphone 9 (3.6), Fentanyl (transdermal) 2 (0.8), Codeine 11 (4.45). | Perioperative daily OME: 20.5 ± 15.9, Perioperative OME above the threshold of 723: 31 (12.3) | Preoperative opioid use was the greatest predictor of postoperative opioid use (OR, 21.29, 95% CI, 12.2–37.15, P < 0.001). |
| Farley et al. | 2020 | 120,569 (56.2) | Hydrocodone, oxycodone, oxymorphone, codeine, dihydrocodeine, morphine, hydromorphone, fentanyl, methadone, meperidine. | <1 OME (n = 16,468 [7.7%]); 1-<5 OMEs (n = 57,378 [26.8%]); 5-<10 OMEs; (n = 13,393 [6.3%]); >10 OMEs (n = 18,450 [8.6%]) | NR |