Patients Utilizing Opioids Before Total Joint Arthroplasty Have Greater Social Determinants of Health Deficits than Opioid-Naïve Patients.

Background: Patients with chronic preoperative opioid use may have worse outcomes after total joint arthroplasty (TJA) than opioid-naïve patients. This study aimed to determine if patients who fill opioid prescriptions before TJA are more likely to have a social determinants of health deficit (SDHD).

Methods: This study included a retrospective, single-institution cohort of patients undergoing TJA for osteoarthritis. Opioid prescription information was queried from a national drug monitoring database and patients were classified as preoperative opioid users if they had at least one filled opioid prescription from one to 30 days and from 31 to 90 days preoperatively, and naïve patients were those who did not have a filled prescription in the year before surgery. Patients were divided by procedure type (total hip arthroplasty [THA] or total knee arthroplasty [TKA]) and each group was matched 3:1 by demographics. Social determinants of health identified included living alone, transportation access, race and ethnicity, insurance type, social vulnerability index (SVI), and area deprivation index (ADI). After matching, 519 opioid-using THA patients were compared with 1,557 naïve THA patients, and 399 opioid-using TKA patients were compared with 1,197 naïve TKA patients.

Results: Opioid-using patients were significantly more likely to not be employed, to have non-commercial insurance, have a psychiatric disorder, and to live alone. Opioid-using TKA patients were significantly more likely to lack transportation access, and opioid-using THA patients were significantly more likely to be Black. Opioid-using patients for both groups also had significantly higher vulnerability scores in the national ADI and across all SVI categories than naïve patients.

Conclusions: Patients using opioids preoperatively are more likely to have an SDHD compared to opioid-naïve patients, which may indicate differences in pathways of care in patients who have SDHD undergoing TJA and further highlights the influence SDHD can have on patient outcomes following TJA.