Implant-Related Complications Among Patients With Opioid Use Disorder Following Primary Total Hip Arthroplasty: A Matched-Control Analysis of 42,097 Medicare Patients |
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| Institution: | 1. Orthopedic Research Institute, Holy Cross Hospital, Fort Lauderdale, FL;2. Department of Orthopedic Surgery, Massachusetts General Hospital, Boston, MA;3. Department of Orthopedic Surgery, Lenox Hill Hospital, Northwell Health, New York, NY;4. Department of Orthopedic Surgery, Cleveland Clinic, Weston, FL;5. Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, OH;1. Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington, CT;2. University of Connecticut School of Medicine, Farmington, CT;3. Department of Orthopaedic Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA;6. Department of Orthopedic Surgery, Seoul Sacred Heart General Hospital, Seoul, Republic of Korea;7. Department of Orthopedic Surgery, Daejeon St. Mary’s Hospital, The Catholic University of Korea School of Medicine, Daejeon, Republic of Korea;8. Department of Orthopedic Surgery, Chonbuk National University Medical School, Jeonju, Republic of Korea;9. Department of Orthopedic Surgery, Asan Medical Center, The University of Ulsan College of Medicine, Seoul, Republic of Korea;10. Department of Orthopaedic Surgery, Center for Joint Diseases and Rheumatism, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea;1. Department of Orthopedic Surgery, Korea University College of Medicine, Korea University Guro Hospital, Seoul, Republic of Korea;2. Department of Orthopedic Surgery, Korea University College of Medicine, Korea University Ansan Hospital, Ansan, Gyeonggi-do, Republic of Korea;3. Yonsei Namu Orthopedic Clinic, Seoul, Republic of Korea;4. Department of Orthopedic Surgery, Seoul Barunsesang Hospital, Seoul, Republic of Korea;5. Department of Orthopaedic Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea |
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| Abstract: | BackgroundOpioid use disorders (OUD) are a major cause of morbidity and mortality. The authors of this study hypothesize that patients who have an OUD will have greater relative risk of implant-related complications, periprosthetic joint infections (PJIs), readmission rates, and will incur greater costs compared to non-opioid use disorder (NUD) patients following primary total hip arthroplasty (THA).MethodsOUD patients who underwent a THA between 2005 and 2014 were identified and matched to controls in a 1:5 ratio according to age, sex, a comorbidity index, and various medical comorbidities yielding 42,097 patients equally distributed in both cohorts. Pearson’s chi-square analyses were used to compare patient demographics. Relative risk (RR) was used to analyze and compare risk of 2-year implant-related complications, 90-day PJIs, and 90-day readmission rates. Welch’s t-tests were used to compare day of surgery and 90-day episode-of-care costs between the cohorts. A P value less than .006 was considered statistically significant.ResultsOUD patients had higher incidences and risks of implant-related complications (11.99% vs 6.68%; RR, 1.74; P < .001), developing PJIs within 90 days (2.38% vs 1.81%; RR, 1.32; P = .001), and 90-day readmissions (21.49% vs 17.35%; RR, 1.23; P < .001). Additionally, the study demonstrated OUD patients incurred greater day of surgery ($14,384.30 vs $13,150.12, P < .0001) and 90-day costs ($21,183.82 vs $18,709.02, P < .0001) compared to controls.ConclusionAfter controlling for age, sex, a comorbidity index, and various medical complications, OUD patients are at greater risk to experience implant-related complications, PJIs, readmissions, and have greater costs following primary THA compared to non-OUD patients. This study should help orthopedic surgeons counsel their patients of potential complications which may arise following their primary THA. |
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| Keywords: | opioids total hip arthroplasty complications revision periprosthetic joint infection |
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