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Model Predicts Persistent Opioid Use After Total Knee Replacement

FRIDAY, Feb. 5, 2021 -- A model with 10 predictors can identify persistent high-dose opioid use in the year following total knee replacement (TKR), according to a study published online Feb. 3 in Arthritis Care & Research.

Chandrasekar Gopalakrishnan, M.D., M.P.H., from Brigham and Women's Hospital in Boston, and colleagues used Medicare claims data for 2010 to 2014 to identify patients 65 years and older who underwent TKR and had no history of high-dose opioid use in the previous year; the final cohort included 142,089 patients. Distinct opioid use patterns were examined; the primary outcome was persistent high-dose opioid use in the year after TKR.

The researchers identified four distinct trajectories of opioid use (short-term, low-dose; moderate-duration, low-dose; moderate-duration, high-dose; and persistent, high-dose [10.6 percent]). In the test set (2014 data), the model predicting persistent high-dose opioid use achieved high discrimination (area under the receiver operating characteristic curve [AUC], 0.85). Equally good performance was achieved for a reduced model with 10 predictors (AUC, 0.84).

"The predictors in the reduced model focused mainly on variables that are well captured in claims such as demographics and prior medication use (including opioid use) and thus may be more generalizable when used in other settings," the authors write. "Using a simple algorithm to preoperatively identify patients at high risk of persistent opioid use may help providers exercise appropriate caution before prescribing opioids after surgery."

Several authors disclosed financial ties to the pharmaceutical industry.

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Posted: February 2021

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