S011: CHRONIC PREOPERATIVE OPIOID USE AND 30- AND 90-DAY READMISSION AFTER TOTAL JOINT ARTHROPLASTY
Peter Hsin1; Bieu Mach1; Samantha Siu1; Sarah Simon1; Da Young Lee1; Sharan Prasad2; Keith Bannerman2; Rose Berkun, MD, FASA3
1Herbert Wertheim College of Medicine; 2Jacobs School of Medicine and Biomedical Sciences; 3Department of Anesthesia, Jacobs School of Medicine and Biomedical Sciences
Background: Opioid-related disorders are increasingly prevalent among patients presenting for total joint arthroplasty (TJA) and may reflect a high-risk perioperative phenotype characterized by medical, psychiatric, and social vulnerability. While chronic opioid exposure has been linked to adverse postoperative outcomes, the association between preoperative opioid-related disorders and short-term hospital readmission after TJA remains incompletely characterized. Improved understanding of this relationship may inform perioperative risk stratification and optimization strategies.
Methods: We performed a retrospective cohort study using the TriNetX Global Collaborative Network, a federated database of de-identified electronic health records from multiple healthcare organizations. Adults undergoing primary total hip or knee arthroplasty were identified. Revision procedures were excluded. Exposure was defined as a documented opioid-related disorder within 180 days prior to surgery. Controls were opioid-naïve patients, defined as having no documented opioid analgesic prescriptions during the same 180-day preoperative window. Propensity score matching (1:1) was conducted to balance baseline demographics and comorbidities, including age, sex, cardiovascular disease, metabolic disorders, psychiatric conditions, chronic kidney disease, chronic pain diagnoses, and substance use disorders. The primary outcomes were 30-day and 90-day all-cause hospital readmission, defined as inpatient encounters occurring within the respective postoperative time windows. Risk differences, risk ratios (RR), and odds ratios (OR) with 95% confidence intervals were calculated.
Results: After propensity score matching, 16,109 patients were included in each cohort with well-balanced baseline characteristics. Patients with a preoperative opioid-related disorder demonstrated significantly higher rates of hospital readmission at both time points. At 30 days, readmission occurred in 8.9% of exposed patients compared with 6.8% of opioid-naïve controls (RR 1.30, 95% CI 1.21–1.41; p<0.001). At 90 days, readmission remained more frequent in the exposed cohort (17.1% vs 13.4%; RR 1.27, 95% CI 1.21–1.34; p<0.001). Absolute risk differences indicated a clinically meaningful increase in readmission associated with preoperative opioid-related disorders.
Conclusions: In this large propensity-matched analysis, a documented opioid-related disorder within 180 days prior to surgery was associated with significantly increased 30- and 90-day hospital readmission following primary total joint arthroplasty. These findings suggest that opioid-related disorders identify a high-risk surgical population and underscore the importance of multidisciplinary perioperative optimization and targeted care pathways to reduce postoperative readmissions and healthcare utilization.
