High Opioid Doses Linked to Increase in Complications after Orthopedic Surgery

San Francisco, CA—April 6, 2017

Higher doses of opioids are associated with an increase in most complications following joint-replacement or spinal fusion surgery, results of a population-based study by researchers at Hospital for Special Surgery (HSS) indicate.

"While opioids play an essential role in managing pain after surgery, they have well-known side effects particularly on the respiratory and gastrointestinal systems," said senior author, researcher and anesthesiologist Stavros Memtsoudis, PhD, MD. "Aside from the escalation of non-clinical opioid use nationwide, evaluating the impact of opioids in the postsurgical setting is a major public health concern."

The researchers, who analyzed postoperative complication and opioid dosage data from over one million patients who underwent joint-replacements and 220,946 patients who underwent spinal fusions, presented their findings at the annual meeting of the American Society of Regional Anesthesiologists on April 6, 2017, in San Francisco, California.

Outcomes of the data from both patient groups – those who had joint-replacements or spinal fusions – were divided into quartiles by opioid dose prescription. The researchers used multilevel multivariable logistic regression models to measure associations between the dosage of opioids prescribed and postoperative outcomes such as myocardial infarction, pulmonary embolism, and postoperative infection.

Compared to the lowest quartile of opioid dosing, high opioid prescription rates were associated with more than 50 percent increased odds for gastrointestinal complications, deep venous thrombosis, and postoperative infections in patients who underwent joint-replacement surgery. Odds were increased by almost 30 percent for pulmonary embolism and more than 15 percent for respiratory and urinary complications following joint-replacement surgery.

Findings for patients who underwent spinal fusions were similar but less pronounced despite higher opioid use.

"In summary our data show that when you prescribe more opioids, you will have more complications," said Dr. Memtsoudis. "These findings are supported by current scientific evidence and provide a basis for policy makers to take action as well as for researchers to engage in formal testing of hypotheses in clinical trials in the context of balancing pain relief and side effects."

"Further, these data should entice clinicians and patients to look for ways to minimize opioid-based pain management and employ alternative strategies, such as the use of regional anesthetic techniques," added Dr. Memtsoudis. "Clearly, the success of surgeries and the health of patients is at risk if we don’t seek alternatives."

Reference

Cozowicz C, Olson A, Poeran J, Mörwald E, Girardi F, Hughes A, Mazumdar M, Memtsoudis SG. Association between levels of opioid prescription and postoperative outcomes in total joint arthroplasties and spinal fusions a population based study. Poster presented at: 2017 ASRA Annual Meeting; April 6-8, 2017; San Francisco, CA.