Nicotine use is associated with elevated risk of opioid use disorder following total/hemi hip arthroplasty procedures.

Abstract

Introduction: Opioids are often necessary for pain control after surgery; however, it is challenging to predict risk of developing opioid use disorder (OUD) after surgical interventions. Nicotine impacts opioid metabolism, which is associated with risk of opioid use disorder (OUD). We aimed to determine whether peri-operative nicotine use is associated with incident OUD following hip arthroplasties.

Methods: We performed a retrospective cohort study using a national de-identified database to identify subjects who underwent total/hemi hip arthroplasty in the United States from 2013-2018 and received post-operative opioid treatment within two weeks of the procedure. The matched cohorts consisted of nicotine dependent (N=10,464) versus non-nicotine dependent individuals (N=10,464). Subjects were matched on known confounders: age, sex, race, ethnicity, alcohol use disorder, sedative-hypnotic/anxiolytic disorders, congestive heart failure, chronic obstructive pulmonary disease, depressive disorders, and anxiety disorders. We assessed for development of OUD, and though IVDU was not directly measured due to data limitations, we assessed for secondary outcomes of OUD associated with IVDU: Human Immunodeficiency Virus (HIV), Hepatitis C Virus (HCV), and Hepatitis B Virus (HBV) at multiple timepoints (1 month, 3 months, 6 months, 1 year, 3 years) after surgery utilizing logistic regression analysis.

Results: Nicotine dependence was associated with increased risk of developing OUD at 3 months post-surgery (OR 2.36 p<0.001) and thereafter (OR 2.37-2.42 p<0.001). Peri-operative nicotine dependence was also associated with HIV (OR 1.26-1.92 p<0.05) and HCV (OR 1.47-1.60 p<0.02) at all timepoints.

Conclusions: Considering nicotine use when determining OUD risk following total/hemi hip arthroplasty procedures is warranted.

Implications: Orthopedic surgeons should monitor individuals who use nicotine products with vigilance for signs and symptoms of OUD post-operatively. The opioid risk tool should be evaluated to determine if inclusion of nicotine products enhances the predictive model. Future research efforts may focus on the impact of pre-surgical smoking cessation on development of OUD.