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  • Tramadol prescribed at discharge is associated with lower odds of chronic opioid use after elective total joint arthroplasty

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Original research
Tramadol prescribed at discharge is associated with lower odds of chronic opioid use after elective total joint arthroplasty
  1. Sara Kiani1,
  2. Jashvant Poeran2,
  3. Haoyan Zhong3,
  4. Lauren A Wilson3,
  5. Lazaros Poultsides4,
  6. Jiabin Liu3 and
  7. Stavros G Memtsoudis3
  1. 1 Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
  2. 2 Departments of Orthopedics / Population Health Science & Policy / Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
  3. 3 Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York City, New York, USA
  4. 4 Academic Orthopedic Department, Aristotle University Medical School, General Hospital Papageorgiou, Thessaloniki, Greece
  1. Correspondence to Dr Stavros G Memtsoudis, Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, New York, NY 10021, USA; memtsoudiss{at}hss.edu

Abstract

Introduction We aimed to study the association between tramadol prescribed at discharge (after elective total hip and knee arthroplasty (THA/TKA) surgery) and chronic opioid use postoperatively.

Methods This retrospective cohort study queried the Truven MarketScan database and identified patients who underwent an elective THA/TKA surgery between 2016 and 2018 and were prescribed opioids at discharge (n=81 049). Multivariable analysis was conducted to study the association between tramadol prescription at discharge and chronic opioid use, with additional analysis adjusting for the amount of opioids prescribed in oral morphine equivalents. Chronic opioid use was defined as filling ≥10 opioid prescriptions or prescriptions for ≥120 pills within the period from 90 days to 1 year after surgery.

Results Overall, tramadol was prescribed at discharge in 11.0% of all THA/TKA cases. Of those, 26.9% and 73.1% received tramadol only or tramadol with another opioid, respectively. Chronic opioid use was observed in 5.4% of cases. After adjustment for relevant covariates, prescription of tramadol combined with another opioid at discharge was associated with lower odds of chronic opioid use comparing to prescription of other opioids (OR 0.69 CI 0.61 to 0.78).

Discussion Among patients undergoing elective THA/TKA surgery and discharged with a prescription of opioids, we found that prescription of tramadol combined with another opioid was associated with lower odds of chronic opioid use. This finding must be considered in the context of the tramadol’s pharmacology, as well-described genetic differences in metabolism that can make it ineffective in many patients, while for patients with ultrarapid metabolism can cause drug–drug interactions and adverse events, including feelings of high and seizures.

  • analgesics, opioid
  • epidemiology
  • outcome assessment, health care

Data availability statement

Data may be obtained from a third party and are not publicly available. The Truven MarketScan database is available for purchase.

https://doi.org/10.1136/rapm-2022-103486

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    Data availability statement

    Data may be obtained from a third party and are not publicly available. The Truven MarketScan database is available for purchase.

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    Footnotes

    • Twitter @saranikkii, @jashvant_p, @jbLiujb, @sgmemtsoudis

    • Contributors SK: writing – original draft, writing – review & editing, visualization; JP: conceptualization, methodology, investigation, writing – review & editing, visualization, supervision; HZ: writing – review & editing, software, formal analysis, data curation; LAW: software, formal analysis, data curation; LP and JL: conceptualization, supervision; SGM: conceptualization, writing – review & editing, visualization supervision. SGM is the study guarantor and accepts full responsibility for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests SGM is the owner of SGM Consulting, LLC and co-owner of Centauros Healthcare Analytics and Consulting, LLC. He is a partner in Parvizi Surgical Innovations, LLC and investor in HATH. He has a US patent application for a Multicatheter Infusion System (US-2017-0361063). SGM is a one-time consultant for Teikoku Pharma. All other authors declare no conflicts of interest.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.