Association between preoperative self-rated health and opioid use 12 months after total hip arthroplasty for osteoarthritis: a cohort study using Danish National Health Survey Data.

Background and purpose:  We examined the association between preoperative self-rated health (SRH) and opioid use 12 months after total hip arthroplasty (THA) for osteoarthritis.

Methods:  We identified 381,323 people who answered a question on SRH in the Danish National Health Surveys 2010, 2013, or 2017. Among these, 4,174 people age > 35 years subsequently underwent THA for osteoarthritis. SRH was categorized as poor ("poor" or "fair" health) or good ("good," "very good," or "excellent" health). Opioid use was defined as ≥ 2 prescriptions 1-12 months after THA. We calculated prevalences and prevalence ratios (PR) with 95% confidence intervals (CI) through log-binomial regression, overall and by preoperative opioid use status adjusting for potential confounders. The total morphine milligram equivalent (MME) dose after THA with interquartile range (IQR) was further calculated.

Results:  876 (21%) patients rated their health as poor and 3,292 (79%) as good. The prevalence of opioid use among patients with poor SRH was higher than among those with good SRH (PR 2.33, CI 2.05-2.65) (315 [36%] vs 132 [14%]). Similarly, among preoperative non-users, the prevalence was 62 (15%) for patients with poor SRH and 140 (6%) for patients with good SRH (PR 2.20, CI 1.65-2.93), and among preoperative users, the prevalence was 252 (54%) for patients with poor SRH and 299 (31%) for patients with good SRH (PR 1.64, CI 1.44-1.86). The overall median MME dose was higher among patients with poor SRH (2,940, IQR 800-9,610) than among those with good SRH (1,000, IQR 400-3,175) with a median difference of 1,940 (IQR 1,227-2,653).

Conclusion:  Compared with good preoperative SRH, poor preoperative SRH was associated with higher opioid use 12 months after THA for osteoarthritis.