From: Risk factors and trajectories of opioid use following total knee replacement
Measurea | Level | Chronicb | Non-chronic | Total | p-Value |
---|---|---|---|---|---|
Unique patientsc | 1054 (69.9%) | 500 (30.1%) | 1507 | ||
Number of total knee surgeries | First surgery | 1050 (69.7%) | 457 (30.3%) | 1507 | 0.059 |
Second surgery | 99 (62.3%) | 60 (37.7%) | 159 | ||
Age, years | Mean [standard deviation (sd)] | 58.7 (9.8) | 62.0 (10.1) | 59.7 (10.0) | < 0.0001 |
Sex | % male | 233 (20.3%) | 98 (19.0%) | 331 (19.9% | 0.53 |
Race/ethnicity | White | 420 (36.6%) | 176 (34.0%) | 596 (35.8%) | 0.044 |
Black | 517 (45.0%) | 223 (43.1%) | 740 (44.4%) | ||
Hispanic | 6 (0.5%) | 9 (1.7%) | 15 (0.9%) | ||
Baseline measures (presurgery periodd) | |||||
Opioid naïvee | 0 days | 222 (19.3%) | 308 (59.6%) | 530 (31.8%) | < 0.0001 |
Opioid use during presurgery period | 0–49 MME/day | 999 (87.0%) | 509 (98.5%) | 1508 (90.5%) | < 0.0001 |
50–89 MME/day | 112 (9.8%) | 8 (1.6%) | 120 (7.2%) | ||
≥ 90 MME/day | 38 (3.3%%) | 0 (0%) | 38 (2.3%) | ||
Opioid usef among all patients | |||||
Mean opioid days, mean (std) | Presurgery period | 44.0 (42.0) | 12.7 (10.6) | 34.2 (35.0) | < 0.0001 |
Exposure periodg | 20.0 (19.5) | 10.5 (9.7) | 17.1 (10.4) | < 0.0001 | |
≥ 90 days postsurgery | 85.4 (81.7) | 0 | 58.9 (66.9) | < 0.0001 | |
Mean MME, mean(std) | Presurgery period | 21.8 (32.6) | 5.9 (12.8) | 17.6 (30.0) | < 0.0001 |
Exposure period | 58.8 (55.6) | 27.5 (25.0) | 49.1 (51.2) | < 0.0001 | |
≥ 90 days postsurgery | 25.1 (41.2) | 0 | 18.5 (42.7) | < 0.0001 | |
Opioid prescriptions dispensed during exposure period | |||||
Mean opioid days | Mean (std) | 21.2 (20.7) | 15.2 (14.4) | 19.7 (8.5) | < 0.0001 |
Opioid prescription count | Mean (std) | 3.1 (1.5) | 2.2 (1.3) | 2.8 (1.5) | < 0.0001 |
Provider practice specialty | Surgeon | 769 (66.9%) | 274 (53.0%) | 1043 (62.6%) | < 0.0001 |
Primary care provider | 173 (15.1%) | 50 (9.7%) | 223 (13.4%) | ||
Concomitant medications dispensed during exposure period (all patients) | |||||
NSAIDS, APAP | 263 (22.9%) | 99 (19.2%) | 362 (21.7%) | 0.089 | |
Antidepressants | 347 (30.2%) | 93 (18.0%) | 440 (26.5%) | < 0.02 | |
Gabapentin, pregabalin | 229 (19.9%) | 51 (9.8%) | 280 (16.8%) | < 0.02 | |
Benzodiazepines | 218 (19.0%) | 40 (7.7%) | 258 (15.5%) | < 0.0001 | |
Selected sedatives/hypnoticsh | 108 (9.4%) | 22 (4.3%) | 130 (7.8% | 0.0002 | |
Muscle relaxants | 161 (14.0%) | 25 (4.8%) | 186 (11.2%) | < 0.0001 | |
Surgery and process of care variables | |||||
Rehospitalization, N (%) | Within 30 days of discharge | 21 (1.8%) | 5 (1.0%) | 26 (1.2%) | 0.28 |
Hospital length of stay | 2 or more nights | 254 (22.1%) | 97 (18.8%) | 351 (21.1%) | 0.13 |
1 night or same day | 895 (77.9%) | 420 (81.2%) | 1315 (78.9%) | ||
Number of unique providers visited (claims data) | Mean (std) | 1.17 (1.09) | 1.00 (0.88) | 1.21 (1.43) | 0.02 |
Count of distinct opioid prescribers (pharmacy data) | Mean (std) | 1.7 (0.85) | 1.0 (0.87) | 1.46 (0.92) | < 0.0001 |