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High Opioid Doses Linked to Increase in Complications after Orthopedic Surgery

San Francisco, CA—April 6, 2017

Higher doses of opioids are associated with an increase in most complications following joint-replacement or spinal fusion surgery, results of a population-based study by researchers at Hospital for Special Surgery (HSS) indicate.

"While opioids play an essential role in managing pain after surgery, they have well-known side effects particularly on the respiratory and gastrointestinal systems," said senior author, researcher and anesthesiologist Stavros Memtsoudis, PhD, MD. "Aside from the escalation of non-clinical opioid use nationwide, evaluating the impact of opioids in the postsurgical setting is a major public health concern."

The researchers, who analyzed postoperative complication and opioid dosage data from over one million patients who underwent joint-replacements and 220,946 patients who underwent spinal fusions, presented their findings at the annual meeting of the American Society of Regional Anesthesiologists on April 6, 2017, in San Francisco, California.

Outcomes of the data from both patient groups – those who had joint-replacements or spinal fusions – were divided into quartiles by opioid dose prescription. The researchers used multilevel multivariable logistic regression models to measure associations between the dosage of opioids prescribed and postoperative outcomes such as myocardial infarction, pulmonary embolism, and postoperative infection.

Compared to the lowest quartile of opioid dosing, high opioid prescription rates were associated with more than 50 percent increased odds for gastrointestinal complications, deep venous thrombosis, and postoperative infections in patients who underwent joint-replacement surgery. Odds were increased by almost 30 percent for pulmonary embolism and more than 15 percent for respiratory and urinary complications following joint-replacement surgery.

Findings for patients who underwent spinal fusions were similar but less pronounced despite higher opioid use.

"In summary our data show that when you prescribe more opioids, you will have more complications," said Dr. Memtsoudis. "These findings are supported by current scientific evidence and provide a basis for policy makers to take action as well as for researchers to engage in formal testing of hypotheses in clinical trials in the context of balancing pain relief and side effects."

"Further, these data should entice clinicians and patients to look for ways to minimize opioid-based pain management and employ alternative strategies, such as the use of regional anesthetic techniques," added Dr. Memtsoudis. "Clearly, the success of surgeries and the health of patients is at risk if we don’t seek alternatives."


Cozowicz C, Olson A, Poeran J, Mörwald E, Girardi F, Hughes A, Mazumdar M, Memtsoudis SG. Association between levels of opioid prescription and postoperative outcomes in total joint arthroplasties and spinal fusions a population based study. Poster presented at: 2017 ASRA Annual Meeting; April 6-8, 2017; San Francisco, CA.


About HSS | Hospital for Special Surgery
HSS is the world’s leading academic medical center focused on musculoskeletal health. At its core is Hospital for Special Surgery, nationally ranked No. 1 in orthopedics (for the ninth consecutive year) and No. 3 in rheumatology by U.S.News & World Report (2018-2019). Founded in 1863, the Hospital has one of the lowest infection rates in the country and was the first in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center four consecutive times. The global standard total knee replacement was developed at HSS in 1969. An affiliate of Weill Cornell Medical College, HSS has a main campus in New York City and facilities in New Jersey, Connecticut and in the Long Island and Westchester County regions of New York State. In 2017 HSS provided care to 135,000 patients and performed more than 32,000 surgical procedures. People from all 50 U.S. states and 80 countries travelled to receive care at HSS. In addition to patient care, HSS leads the field in research, innovation and education. The HSS Research Institute comprises 20 laboratories and 300 staff members focused on leading the advancement of musculoskeletal health through prevention of degeneration, tissue repair and tissue regeneration. The HSS Global Innovation Institute was formed in 2016 to realize the potential of new drugs, therapeutics and devices. The culture of innovation is accelerating at HSS as 130 new idea submissions were made to the Global Innovation Institute in 2017 (almost 3x the submissions in 2015). The HSS Education Institute is the world’s leading provider of education on the topic of musculoskeletal health, with its online learning platform offering more than 600 courses to more than 21,000 medical professional members worldwide. Through HSS Global Ventures, the institution is collaborating with medical centers and other organizations to advance the quality and value of musculoskeletal care and to make world-class HSS care more widely accessible nationally and internationally.


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