Association of preoperative corticosteroids with persistent opioid requirements following total knee arthroplasty: an exploratory population-based cohort study.

Abstract

Background: Used to suppress inflammation, preoperative corticosteroid exposure is common among patients undergoing total knee arthroplasty (TKA). New preclinical evidence links corticosteroid exposure to developing chronic pain, which may lead to long-term opioid treatment. We aimed to explore whether there is an association between preoperative corticosteroid exposure and persistent opioid requirements in previously opioid-naïve patients undergoing TKA.

Methods: In an exploratory retrospective cohort study, we searched a nationwide USA claims database for patients who were opioid-naïve and underwent primary TKA between January 2010 and October 2022. Our primary objective was to explore the magnitude of any association between preoperative corticosteroid claims (oral/parenteral/intra-articular) and postoperative opioid prescription claims at 3 months using multivariable logistic regression. Our secondary objective was to explore the association at 6 months.

Results: The matched cohort included 763,530 patients who were opioid-naïve; of those, 27,510 did and 736,020 did not have preoperative corticosteroid claims within 30 days of TKA. At 3 months, 5,015 patients (18.2%) had corticosteroid and opioid claims, while only 95,230 (12.9%) without corticosteroid claims had opioid claims (P < 0.001). Similarly, at 6 months, 2,425 patients (8.8%) had corticosteroid and opioid claims, while only 49,712 (6.8%) without corticosteroid claims had opioid claims (P < 0.001). The odds ratio (confidence interval [CI]) for opioid claims at 3 and 6 months among patients with corticosteroid claims were 1.34 (95% CI, 1.30 to 1.38; P < 0.001) and 1.20 (97.5% CI, 1.15 to 1.25; P < 0.001), respectively.

Conclusions: Our exploratory retrospective cohort study suggests that, after accounting for other potential covariates, patients who were previously opioid-naïve and who were exposed to preoperative corticosteroids may have greater odds (or risk given the low incidence) of persistent opioid claims at 3 and 6 months after TKA. This association may have important clinical implications and requires validation through further observational and randomized studies.