Association between perceived stress and the risk of continued opioid use after total hip arthroplasty in patients with osteoarthritis: a Danish registry-based study of 1,727 individuals.

Background and purpose:  Continued opioid use persists in up to one-third of patients 12 months after total hip arthroplasty (THA). Psychological factors, including stress, may influence pain and therefore opioid consumption, yet the effect of stress history on opioid use after THA remains unclear. We aimed to examine the association between perceived stress and the risk of continued opioid use following THA in patients with osteoarthritis.

Methods:  Based on data from the Danish National Health Surveys in 2013 and 2017, a total of 1,727 individuals completed the Perceived Stress Scale and later underwent THA, tracked through the Danish Hip Arthroplasty Registry. All were over the age of 35. Patients were classified by stress level (high vs low stress). Continued opioid use was defined as ≥ 2 opioid prescriptions 1-12 months post-surgery, recorded in the Danish National Prescription Database. Adjusted prevalence differences and adjusted prevalence ratios were calculated using log-binomial regression, controlling for sex, age, comorbidities, and education.

Results:  Of 258 patients with high stress level, 68 (26%) had continued opioid use, compared with 224 (15%) of the 1,469 patients with a low level. We showed higher ratios in high stress patients (adjusted prevalence difference 9.2; 95% confidence interval [CI] 3.6-14.8, adjusted prevalence ratio 1.5 [CI 1.2-1.9]). Median morphine milligram equivalents (MME) were higher for high stress with a median difference of 1,230 (interquartile range 1,025-3,745).

Conclusion:  High levels of perceived stress before THA are associated with a higher risk of continued opioid use and greater opioid consumption in the first postoperative year. These findings suggest the potential for preoperative stress screening and targeted interventions to reduce postoperative opioid use.