Retrospective Cohort Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Aug 18, 2022; 13(8): 703-713
Published online Aug 18, 2022. doi: 10.5312/wjo.v13.i8.703
Fluctuation of visual analog scale pain scores and opioid consumption before and after total hip arthroplasty
Vivek Singh, Alex Tang, Thomas Bieganowski, Utkarsh Anil, William Macaulay, Ran Schwarzkopf, Roy I Davidovitch
Vivek Singh, Alex Tang, Thomas Bieganowski, Utkarsh Anil, William Macaulay, Ran Schwarzkopf, Roy I Davidovitch, Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY 10010, United States
Author contributions: Singh V, Tang A, and Bieganowski T write the manuscript; Singh V collected the data; Singh V and Anil U did the analysis; Macaulay W did the edits. Schwarzkopf R and Davidovitch RI are responsible for conceptualization and manuscript editing.
Institutional review board statement: The present study retrospectively analysed de-identified data for institutional quality improvement initiative and was therefore exempted from human-subjects review by our Institutional Review Board.
Informed consent statement: Informed consent was not needed for this study. This was a quality improvement initiative at our institution.
Conflict-of-interest statement: Singh V, Tang A, Bieganowski T and Anil U have nothing to disclose. Macaulay W holds stock options in OrthoAlign. Schwarzkopf R is a paid consultant for Smith & Nephew and Intellijoint. He also has stock options in Gauss Surgical outside the submitted work. Davidovitch RI is a paid consultant for Radlink, Schaerer Medical, Exactech, and Medtronics.
Data sharing statement: The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Vivek Singh, MD, Doctor, Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, 301 E 17th Street, New York, NY 10010, United States. vivek.singh@nyulangone.org
Received: October 1, 2021
Peer-review started: October 1, 2021
First decision: January 11, 2022
Revised: January 28, 2022
Accepted: July 22, 2022
Article in press: July 22, 2022
Published online: August 18, 2022
Processing time: 319 Days and 10.4 Hours
Abstract
BACKGROUND

Patients who undergo orthopedic procedures are often given excess opioid medication. Understanding the relationship between pain and opioid consumption following total hip arthroplasty (THA) is key to creating safe and effective opioid prescribing guidelines.

AIM

To evaluate the association between the quantity of opioid consumption in relation to pain scores both pre-and postoperatively in patients undergoing primary THA.

METHODS

We retrospectively reviewed patients who underwent primary THA from November 2018-May 2019 and answered both the visual analog scale (VAS) pain and opioid medication questionnaires pre-and postoperatively. Both surveys were delivered daily for 7-days before surgery through the first 30 postoperative days. Survey results were divided into preoperative, postoperative days 1-7, postoperative days 8-14, and postoperative days 15-30 for analysis. Mean opioid pill consumption and VAS pain scores in each time period were determined and compared to patients’ preoperative status using hierarchical Poisson and linear regressions, respectively.

RESULTS

There were 105 patients included. Mean VAS pain scores were the highest preoperatively 7.41 ± 1.72. However, VAS pain scores significantly declined in each successive postoperative category compared to preoperative scores: postoperative day 1-7 (5.07 ± 1.79; P < 0.001), postoperative day 8-14 (3.60 ± 1.64; P < 0.001), and postoperative day 15-30 (3.15 ± 1.63; P < 0.001). Mean opioid pill consumption preoperatively was 0.68 ± 1.29 pills. Compared to preoperative opioid consumption, opioid use was significantly greater between postoperative days 1-7 (1.51 ± 1.58; P = 0.001) and postoperative days 8-14 (1.00 ± 1.27; P = 0.043). Opioid consumption declined below preoperative levels between postoperative days 15-30 (0.35 ± 0.72; P = 0.160) which correlates with a VAS pain score of 3.15.

CONCLUSION

All patients experienced significant benefit and pain relief from having undergone THA. Average postoperative opioid consumption decreased below preoperative consumption between postoperative days 15-30, which was associated with a VAS pain score of 3.15. These results can be used to appropriately guide opioid prescribing practices and set patient expectations regarding pain management following THA.

Keywords: Opioids; Narcotics; Pain; Visual analog scale; Total hip arthroplasty

Core Tip: Our results should be used to appropriately guide opioid prescribing patterns and set patient expectations regarding expected pain management following total hip arthroplasty (THA). This will not only give patients a baseline to reference during their recovery but also limit redundant billing expenses related to unnecessary prescription of medication and avoidable outpatient visits due to post-operative pain. However, without further research that considers other patient factors that influence pain severity, our understanding of the independent impact of pain on opioid consumption after THA remains uncertain.