AAOS News: Study Reveals Benefits of Ending Opioid Use Three Months Before Surgery

As opioid usage rises, one study presented today at the 2019 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS) found that chronic users who stopped taking opioids three months before major total joint arthroplasty and spinal fusion surgeries reduced the risk of chronic use following surgery.
 
The study, “Orthopaedic Surgeries Decrease Chronic Opioid Use: The Relationship Between Preoperative and Postoperative Opioid Use Patterns,” examined 98,769 patients via a database who had anterior cervical decompression and fusion (ACDF), posterior lumbar fusion (PLF), carpal tunnel release (CTR), rotator cuff repair (RCR), total knee arthroplasty (TKA), total hip arthroplasty (THA), and total shoulder arthroplasty (TSA). Chronic preoperative opioid use was associated with an increased risk after surgery; however, even chronic users who didn’t have a prescription filled within three months prior to surgery had a lower risk of using opioids following surgery.
 
“One of the most powerful findings was that when we looked at all the procedures, the group that chronically used opioids but had stopped for three months before surgery, had a much lower use of chronic opioids postoperative,” said Dr. Frank M. Phillips, professor and director, Section of Minimally Invasive Spine Surgery, and director, Division of Spine Surgery, Rush University Medical Center in Chicago, Ill.
 
“The message to surgeons is that you should really work on getting patients off opioids for at least three-months before surgery to significantly reduce the chance of chronic use,” added Dr. Phillips. “However, it’s not just about post-surgery addiction. The negative consequences of opioid use postop include a higher risk of infection and emergency visits, as well as a host of other adverse events.”
 
Opioid use is a chronic issue in the United States. Around 21 percent to 29 percent of patients who are prescribed opioids for chronic pain misuse them.ⁱ While the overall opioid prescribing rate has declined since 2012, the amount of opioids prescribed per person is around three times higher than in 1999.ⁱⁱ
 
The AAOS has been working on a number of strategies that aim to limit the quantity of opioids on the market and to encourage its members to practice safe and effective pain management and treatment. A pain relief toolkit for physicians is available, and offers safe disposal strategies, and discussion guides to help navigate conversations with patients and other stakeholders.
 
Additional study findings included:

• Preoperative and postoperative opioid use varied according to the type of orthopaedic procedure. PLF patients had the highest rate of chronic use prior to surgery (28 percent) while CTR patients had the least (12 percent).
• Surgery led to a decreased use of opioids postoperatively—42 percent to 62 percent of chronic preoperative opioid users discontinued opioids following orthopaedic surgery.
• A small group of opioid naïve patients preoperatively ended up becoming chronic users postoperatively. After PLF, 5 percent of opioid naïve patients used opioids chronically as compared to less than one percent of CTR patients.

 
“Sustained opioid use following surgery has become a major public health concern,” said Safdar N. Khan, M.D., associate professor and chief, Division of Spine Surgery, Department of Orthopaedic Surgery, Wexner Medical Center at The Ohio State University. “We plan to utilize these findings to launch a prospective study looking at how varying opioid weaning time periods impact the chronic opioid use and short-term outcomes.”
 
With more than 39,000 members, the American Academy of Orthopaedic Surgeons is the world’s largest medical association of musculoskeletal specialists. The AAOS is the trusted leader in advancing musculoskeletal health. It provides the highest quality, most comprehensive education to help orthopaedic surgeons and allied health professionals at every career level best treat patients in their daily practices. The AAOS is the source for information on bone and joint conditions, treatments and related musculoskeletal health care issues and it leads the health care discussion on advancing quality.

References
ⁱ  Vowles KE, McEntee ML, Julnes PS, Frohe T, Ney JP, van der Goes DN. Rates of opioid misuse, abuse, and addiction in chronic pain: a systematic review and data synthesis. Pain. 2015;156(4):569-576.
ⁱⁱ Centers for Disease Control and Prevention. Vital Signs: Changes in Opioid Prescribing in the United States, 2006–2015. MMWR 2017; 66(26):697-704. Accessed 1/30/19.