The Association of Preoperative Opioid Use With Revision Surgery and Complications Following Carpometacarpal Arthroplasty

Purpose Preoperative opioid use has been shown to be associated with poor outcomes following different upper-extremity surgeries. We aimed to examine the relationship between preoperative opioid use and outcomes following carpometacarpal (CMC) arthroplasty. We hypothesized that patients prescribed higher daily average numbers of preoperative oral morphine equivalents (OMEs) would show higher rates of complications and revision surgery. Methods In the Truven Health MarketScan Database, we identified all patients who underwent CMC arthroplasty from 2009 to 2018. We separated them into cohorts based on average daily OMEs prescribed in the 6 months prior to the surgery: opioid naive, <2.5, 2.5 to 5, 5 to 10, and >10 OMEs per day. We retrieved 90-day complications and 3-year revision surgery data, and we compared these outcomes by opioid-use groups. Results We identified 40,141 patients. The majority (55.9%) were opioid naive, with the next most common group receiving a daily average of <2.5 OMEs (19.2%). Complications increased with increased preoperative OMEs. Multivariable analysis revealed that patients taking >10 OMEs per day had a 1.45% increase in 3-year revision surgery compared with opioid-naive patients, which equated to 2.12 (confidence interval [CI]: 1.33-3.36) times increased odds. Additionally, patients taking >10 OMEs had increased odds of an emergency department visit (odds ratio [OR]: 1.60, CI: 1.43-1.78), a 90-day hospital admission (OR: 2.34, CI: 1.97-2.79), and surgical site infection (OR, 2.02, CI: 1.59-2.54) compared with opioid-naive patients, with absolute differences of 4.53%, 2.78%, and 1.22% compared with opioid-naive patients, respectively. Additionally, preoperative opioid use predicted both number of prescriptions filled in the short term and long term continued opioid use. Conclusions Preoperative opioid use of >10 OMEs per day is associated with a higher risk for complications and revision surgery following CMC arthroplasty. Our findings demonstrate a dose dependent relationship between opioid use and postoperative complications. Further study is necessary to determine if reducing opioid use prior to CMC arthroplasty may reduce the likelihood of these negative outcomes. Copyright (C) 2021 by the American Society for Surgery of the Hand. All rights reserved.) Type of study/level of evidence Prognostic II.