Prevalence and risk factors for prolonged opioid use after total joint arthroplasty: a systematic review, meta-analysis, and meta-regression

Abstract

Purpose

Opioids are a mainstay for pain management after total joint arthroplasty (TJA). The prevalence and risk factors for prolonged opioid use after TJA are important to understand to help slow the opioid epidemic. We aim to summarize and evaluate the prevalence and time trend of prolonged opioid use after TJA and pool its risk factors.

Methods

Following the preferred reporting items for systematic reviews and meta-analysis statement, we systematically searched PubMed, the Cochrane Library, and EMBASE, etc. from inception up to October 1, 2019. Cohort studies reporting risk factors for prolonged opioids use (≥ 3 months) after TJA were included. Studies characteristics, risk ratios (RR), and prevalence of prolonged opioid use were extracted and synthesized.

Results

A total of 15 studies were published between 2015 and 2019, with 416,321 patients included. 12% [95%CI 10–14%] of patients had prolonged opioid use after TJA and its time trend was associated with median enrollment years (P = 0.0013). Previous opioid use (RR = 1.73; P < 0.001), post-traumatic stress disorder (RR = 1.34; P < 0.001), benzodiazepine use (RR = 1.38; P < 0.001), tobacco abuse (RR = 1.26; P < 0.001), fibromyalgia (RR = 1.51; P < 0.001), and back pain (RR = 1.34; P < 0.001) were the largest effective risk factors for prolonged use of opioids.

Conclusions

To our knowledge, this is the first meta-analysis determining the risk factors of prolonged opioid use and characterizing its rate and time trend in TJA. Understanding risk factors for patients with higher potential for prolonged opioids use can be used to implement appropriate management strategies, reduce unsafe opioid prescriptions, and decrease the risk of prolonged opioid use after TJA.

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Funding

This study was supported through grants from the National Natural Science Foundation of China (81802210 and 81672219), National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University (Z20191008), the Key Project of Sichuan Science and Technology Department (2018SZ0223 and 2018SZ0250), and the National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University (Z2018B20).

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Correspondence to Bin Shen.

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Wu, L., Li, M., Zeng, Y. et al. Prevalence and risk factors for prolonged opioid use after total joint arthroplasty: a systematic review, meta-analysis, and meta-regression. Arch Orthop Trauma Surg (2020). https://doi.org/10.1007/s00402-020-03486-4

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Keywords

  • Opioid
  • Prolonged
  • Long-term
  • Total joint arthroplasty
  • Risk factors
  • Prevalence