Substance Use
Continuation of Medication-Assisted Treatment Following Hip and Knee Total Joint Surgery in Patients with Opioid Use Disorder Haoyan Zhong* Haoyan Zhong Zachary Shahn Faye Rim Lisa Reisinger
Background: Total hip and knee arthroplasty often involves short-term opioid use for postoperative pain, particularly challenging for those with a medication-assisted treatment (MAT) history. Medications like methadone and buprenorphine, known for receptor binding affinity and extended half-life, may hinder traditional opioid analgesic effects, raising the risk of uncontrolled postoperative pain. However, abrupt MAT discontinuation during the perioperative period may heighten relapse risk for those with opioid use disorder. Our goal, through longitudinal analysis of Marketscan database, is to assess MAT’s impact on chronic opioid use in patients with a MAT history undergoing total hip and knee surgeries.
Method: The study focused on patients having elective hip and knee surgeries (2017-2021) who received methadone or buprenorphine prescriptions within 30 days before surgery. The primary outcome was total opioid prescribed (oral morphine equivalent of MAT and short-term opioid) 60-90 days post-surgery. We examined MAT continuation post-surgery as the exposure, identifying discontinuation with a >7-day gap between the first MAT refill post-surgery and the last pre-surgery MAT consumption. Inverse Probability of Censoring Weights model was used accounting for the probabilities of both exposure and censoring within 90 days after surgery. (Figure 1)
Results: Our analysis incorporated a total of 321 adult patients; 58.6% of patients showed continuation use of MAT after surgery. After adjusting for confounders and censoring, the difference in total opioid filled 60-90 days after surgery between the continuation and discontinuation groups was 1621 (95% CIs: -901, 4144); and the difference in short-term opioid filled was -237 (95% CIs: -689, 215)
Conclusions: No significant difference in opioid use was observed between patients continuing and discontinuing MAT after surgery, with sizable confidence intervals in both directions. Similar studies on larger samples are needed.
