Preoperative Opioid Use Impacts Postoperative Patient-Reported Outcomes after Total Joint Arthroplasty: A Systematic Review and Meta-Analysis
Supervisor / Principle Investigator:
MD Class of 2020
Background: A significant number of patients are using opioids prior to total joint arthroplasty (TJA), however the impact of preoperative opioid use on postoperative outcomes is not clearly understood. Therefore, we completed a systematic review and meta-analysis comparing patient-reported outcomes (PRO) among those who were, and were not, prescribed opioids prior to TJA.
Methods: A systematic search was performed using Ovid, Embase, Cochrane Library, Scopus, Web of Science Core Collection, CINAHL. Studies reporting postoperative PRO among those prescribed preoperative opioids and those who were not prior to TJA were included. Meta-analysis was performed with studies that included both preoperative and postoperative PRO to determine absolute differences and relative change in PRO measures between the two groups.
Results: Six studies were included (n=7356 patients); overall 24.4% of patients were prescribed preoperative opioids. Patients with preoperative opioid use had worse absolute postoperative PRO when compared to those with no preoperative opioid use (standardized mean difference (SMD) -0.55, 95% Confidence interval (CI) -0.77, -0.33, p=0.001). When change in PRO score was analyzed, as measured by difference between postoperative and preoperative PRO scores, there was no group difference (SMD -0.27, 95% CI -0.55, 0.02, p=0.06).
Conclusion: Patients prescribed preoperative opioids may attain worse overall pain and function benefits after TJA, compared to opioid-naïve patients, but do still benefit from undergoing TJA. These results suggest preoperative opioid weaning/cessation, or counselling regarding postoperative expectations should be considered for preoperative opioid users.