Roughly 40% of patients in need of knee, hip or shoulder joint replacement are prescribed opioids prior to surgery. However, preoperative opioid use is associated with worse patient outcomes, higher health plan costs, higher opioid use during the surgical hospital stay, and a lower likelihood of discontinuing opioids after surgery.
In our most recent study featured in Pain Medicine Journal, we analyzed the effects of opioid use on outcomes during the surgical hospital stay and up to 18 months following surgery for nearly 35,000 privately insured patients undergoing a planned knee, hip or shoulder joint replacement. By leveraging data that spanned nationally across multiple healthcare institutions, our study produced generalizable results that are not limited by institutional standards of care like previous studies.
We found that preoperative opioid users had longer length of hospital stay, increased unplanned readmission, higher surgical site infection, increased revision rates, higher health plan spend, and persistent opioid use that worsened with dose. The higher the opioid dose, the worse the observed effect on these outcomes.
As we move toward value-based care and risk bearing payment models, health plans and providers need to understand cost drivers and patient risk factors for these types of procedures. If preoperative opioid use contributes to outcomes that drive up costs, health plans may consider incentivizing providers for medically managed opioid dose reduction leading up to surgery or even requiring managed opioid tapering for high risk patients prior to approving coverage and reimbursement for some procedures.
The study results are not only valuable for providers and health plans but patients, too. This analysis may help patients understand why their doctor has recommended gradually lowering their opioid dose in the months leading up to elective surgery. Not only does lowering their dose or safely discontinuing opioids prior to a procedure increase their likelihood of a successful surgery, but it may even increase their chances of no longer requiring opioids for pain relief in the months following the procedure.
At axialHealthcare, we strive to promote the highest quality care for patients by not only basing our solutions off the most credible evidence-based research on pain and opioid care but by expanding the literature base on the relationship between opioid use and patient health outcomes. Read the full study in Pain Medicine Journal.