Social Determinants of Health Disparities Are Associated With Prolonged Opioid Utilization After Total Joint Arthroplasty

Abstract

Background: Social determinants of health disparities (SDHDs) have been associated with an increased risk of poor outcomes after total joint arthroplasty (TJA). The purpose of this study was to assess whether SDHDs are associated with prolonged postoperative opioid use after primary TJA.

Methods: This study was a single-institution, retrospective cohort study of patients undergoing primary, unilateral TJA. Opioid prescriptions for these patients were queried in a Prescription Drug Monitoring Program. Patients who had an opioid prescription filled within one year preoperatively were excluded. Patients were divided by procedure (total hip arthroplasty [THA] versus total knee arthroplasty [TKA]) and split into five cohorts: no postoperative opioid prescription filled, or the last prescription filled within zero to 30, 31 to 90, 91 to 180, or 181 to 365 days postoperatively. Patients were excluded if they did not fill postoperative opioid prescriptions in consecutive time frames. We identified 7,671 eligible patients who underwent THA and 7,707 who underwent TKA.

Results: The mean overall Social Vulnerability Index (SVI) score increased, indicating greater socioeconomic vulnerability, with a later last fill date, with significant differences across cohorts for THA (P < 0.001) and TKA (P = 0.026) patients. In multilinear regression analyses, the last fill date in the 31- to 90-day and 181- to 365-day windows was positively predictive of higher SVI scores for THA patients (P = 0.002 and 0.005, respectively), but the last fill date window was not significantly predictive of SVI scores for TKA patients.

Conclusions: Opioid-naïve patients had low rates of continued opioid prescription filling after TJA, but patients continuing to fill prescriptions in the year after surgery live in areas with greater vulnerability, with longer postoperative opioid use positively predictive of overall SVI for THA patients. Patients who have SDHDs may benefit from additional education to avoid prolonged opioid use after TJA.

Keywords: opioid; social determinants of health; social determinants of health disparities; total hip arthroplasty; total joint arthroplasty; total knee arthroplasty.