Effect of Opioids on All-cause Mortality and Opioid Addiction in Total Hip Arthroplasty: a Korea Nationwide Cohort Study
The purpose of this study was to investigate the use of opioids before and after total hip arthroplasty (THA), to find out the effect of opioid use on mortality in patients with THA, and to analyze whether preoperative opioid use is a risk factor for sustained opioid use after surgery using Korean n...
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Published in | Journal of Korean medical science Vol. 36; no. 13; p. e87 |
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Main Authors | , , , , , |
Format | Journal Article |
Language | English |
Published |
Korea (South)
The Korean Academy of Medical Sciences
05.04.2021
대한의학회 |
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Abstract | The purpose of this study was to investigate the use of opioids before and after total hip arthroplasty (THA), to find out the effect of opioid use on mortality in patients with THA, and to analyze whether preoperative opioid use is a risk factor for sustained opioid use after surgery using Korean nationwide cohort data.
This retrospective nationwide study identified subjects from the Korean National Health Insurance Service-Sample cohort (NHIS-Sample) compiled by the Korean NHIS. The index date (time zero) was defined as 90 days after an admission to a hospital to fulfill the eligibility criteria of the THA.
In the comparison of death risk according to current use and the defined daily dose of tramadol and strong opioids in each patient group according to past opioid use, there were no statistically significant differences in the adjusted hazard ratio for death compared to the current non-users in all groups (
> 0.05). Past tramadol and strong opioid use in current users increased the risk of the sustained use of tramadol and strong opioids 1.45-fold (adjusted rate ratio [aRR]; 95% confidence interval [CI], 1.12-1.87;
= 0.004) and 1.65-fold (aRR; 95% CI, 1.43-1.91;
< 0.001), respectively, compared to past non-users.
In THA patients, the use of opioids within 6 months before surgery and within 3 months after surgery does not affect postoperative mortality, but a past-use history of opioid is a risk factor for sustained opioid use. Even after THA, the use of strong opioids is observed to increase compared to before surgery. |
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AbstractList | The purpose of this study was to investigate the use of opioids before and after total hip arthroplasty (THA), to find out the effect of opioid use on mortality in patients with THA, and to analyze whether preoperative opioid use is a risk factor for sustained opioid use after surgery using Korean nationwide cohort data.
This retrospective nationwide study identified subjects from the Korean National Health Insurance Service-Sample cohort (NHIS-Sample) compiled by the Korean NHIS. The index date (time zero) was defined as 90 days after an admission to a hospital to fulfill the eligibility criteria of the THA.
In the comparison of death risk according to current use and the defined daily dose of tramadol and strong opioids in each patient group according to past opioid use, there were no statistically significant differences in the adjusted hazard ratio for death compared to the current non-users in all groups (
> 0.05). Past tramadol and strong opioid use in current users increased the risk of the sustained use of tramadol and strong opioids 1.45-fold (adjusted rate ratio [aRR]; 95% confidence interval [CI], 1.12-1.87;
= 0.004) and 1.65-fold (aRR; 95% CI, 1.43-1.91;
< 0.001), respectively, compared to past non-users.
In THA patients, the use of opioids within 6 months before surgery and within 3 months after surgery does not affect postoperative mortality, but a past-use history of opioid is a risk factor for sustained opioid use. Even after THA, the use of strong opioids is observed to increase compared to before surgery. Background: The purpose of this study was to investigate the use of opioids before and after total hip arthroplasty (THA), to find out the effect of opioid use on mortality in patients with THA, and to analyze whether preoperative opioid use is a risk factor for sustained opioid use after surgery using Korean nationwide cohort data. Methods: This retrospective nationwide study identified subjects from the Korean National Health Insurance Service-Sample cohort (NHIS-Sample) compiled by the Korean NHIS. The index date (time zero) was defined as 90 days after an admission to a hospital to fulfill the eligibility criteria of the THA. Results: In the comparison of death risk according to current use and the defined daily dose of tramadol and strong opioids in each patient group according to past opioid use, there were no statistically significant differences in the adjusted hazard ratio for death compared to the current non-users in all groups (P > 0.05). Past tramadol and strong opioid use in current users increased the risk of the sustained use of tramadol and strong opioids 1.45-fold (adjusted rate ratio [aRR]; 95% confidence interval [CI], 1.12–1.87; P = 0.004) and 1.65-fold (aRR; 95% CI, 1.43–1.91; P < 0.001), respectively, compared to past non-users. Conclusion: In THA patients, the use of opioids within 6 months before surgery and within 3 months after surgery does not affect postoperative mortality, but a past-use history of opioid is a risk factor for sustained opioid use. Even after THA, the use of strong opioids is observed to increase compared to before surgery. KCI Citation Count: 0 BACKGROUNDThe purpose of this study was to investigate the use of opioids before and after total hip arthroplasty (THA), to find out the effect of opioid use on mortality in patients with THA, and to analyze whether preoperative opioid use is a risk factor for sustained opioid use after surgery using Korean nationwide cohort data. METHODSThis retrospective nationwide study identified subjects from the Korean National Health Insurance Service-Sample cohort (NHIS-Sample) compiled by the Korean NHIS. The index date (time zero) was defined as 90 days after an admission to a hospital to fulfill the eligibility criteria of the THA. RESULTSIn the comparison of death risk according to current use and the defined daily dose of tramadol and strong opioids in each patient group according to past opioid use, there were no statistically significant differences in the adjusted hazard ratio for death compared to the current non-users in all groups (P > 0.05). Past tramadol and strong opioid use in current users increased the risk of the sustained use of tramadol and strong opioids 1.45-fold (adjusted rate ratio [aRR]; 95% confidence interval [CI], 1.12-1.87; P = 0.004) and 1.65-fold (aRR; 95% CI, 1.43-1.91; P < 0.001), respectively, compared to past non-users. CONCLUSIONIn THA patients, the use of opioids within 6 months before surgery and within 3 months after surgery does not affect postoperative mortality, but a past-use history of opioid is a risk factor for sustained opioid use. Even after THA, the use of strong opioids is observed to increase compared to before surgery. |
Author | Cha, Yonghan Hwang, Jeong Won Choy, Wonsik Choi, Hyo Gil Jang, Suk Yong Yoo, Jun Il |
AuthorAffiliation | 2 Department of Preventive Medicine, Eulji University College of Medicine, Daejeon, Korea 3 Department of Orthopaedic Surgery, Gyeongsang National University Hospital, Jinju, Korea 1 Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, Korea |
AuthorAffiliation_xml | – name: 3 Department of Orthopaedic Surgery, Gyeongsang National University Hospital, Jinju, Korea – name: 1 Department of Orthopaedic Surgery, Eulji University Hospital, Daejeon, Korea – name: 2 Department of Preventive Medicine, Eulji University College of Medicine, Daejeon, Korea |
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Cites_doi | 10.1016/j.arth.2019.05.050 10.2106/00004623-200704000-00012 10.1097/BOT.0000000000000561 10.2147/JPR.S144066 10.5371/hp.2016.28.1.15 10.1002/acr.22360 10.1016/j.arth.2018.12.023 10.1016/j.joca.2017.04.002 10.1186/s12891-016-0970-6 10.1097/BTO.0000000000000241 10.1136/bmjopen-2018-024344 10.1186/s13075-019-2004-x 10.1097/01.mlr.0000182534.19832.83 10.1097/j.pain.0000000000000516 10.2106/JBJS.17.01617 10.1186/s12891-019-2411-9 10.1093/pm/pnz154 10.2106/JBJS.18.01005 10.1136/bmjopen-2017-016640 10.1186/s12891-019-2619-8 10.1016/j.arth.2018.07.002 10.1097/BOT.0000000000001118 10.1016/j.bja.2019.08.012 10.1111/trf.15330 10.1007/s00264-014-2298-x 10.1002/ejp.1392 10.1001/jamanetworkopen.2019.8061 10.1007/s11999-015-4173-5 |
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Keywords | Opioid Nationwide Cohort Study Addiction Mortality Total Hip Arthroplasty |
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Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Yonghan Cha and Suk-Yong Jang contributed equally to this work. |
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Title | Effect of Opioids on All-cause Mortality and Opioid Addiction in Total Hip Arthroplasty: a Korea Nationwide Cohort Study |
URI | https://www.ncbi.nlm.nih.gov/pubmed/33821594 https://search.proquest.com/docview/2509267039 https://pubmed.ncbi.nlm.nih.gov/PMC8021974 https://www.kci.go.kr/kciportal/ci/sereArticleSearch/ciSereArtiView.kci?sereArticleSearchBean.artiId=ART002704027 |
Volume | 36 |
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ispartofPNX | Journal of Korean Medical Science, 2021, 36(13), , pp.1-12 |
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