The impact of COVID-19 on opioid use in those awaiting hip and knee arthroplasty: A retrospective cohort study

L. Farrow* (Corresponding Author), W.T. Gardner, C. Tang, R. Low, P. Forget, G.P. Ashcroft

*Corresponding author for this work

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Background:COVID-19 has had a detrimental impact on access to hip and knee arthroplasty surgery. We set outto examine whether this had a subsequent impact on pre-operative opioid prescribing rates forthose awaiting surgery.
Materials and Methods: Data regarding patient demographics and opioid utilisation were collected from the electronichealth records of included patients at a large university teaching hospital. Patients on the outpatientwaiting list for primary hip and knee arthroplasty as of September 2020 (COVID-19 group) werecompared with historical controls (Controls) who had previously undergone surgery. A sample sizecalculation indicated 452 patients were required to detect a 15% difference in opioid prescriptionrates between groups.
Results: A total of 548 patients (58.2% female) were included, 260 in the COVID-19 group, and 288 in theControls. Baseline demographics were similar between the groups. For those with data available,the proportion of patients on any opioid at follow up in COVID-19 group was significantly higher:55.0% (143/260), compared with 41.2% (112/272) in the Controls (p=0.002). This remained significant when adjusted for confounding (age, gender, Scottish Index of Multiple Deprivation, procedure and wait time). The proportion of patients on a strong opioid was similar (4.2% [11/260]versus 4.8% [13/272]) for COVID-19 and Controls respectively. The median waiting time from referral to follow up was significantly longer in the COVID-19 group compared with the Controls (455 days vs367 days; p<0.0001).
Conclusion: The work provides evidence of potential for an emerging opioid problem associated with theinfluence of COVID-19 on elective arthroplasty services. Viable alternatives to opioid analgesia forthose with end-stage arthritis should be explored, and prolonged waiting times for surgery ought tobe avoided in the recovery from COVID-19 to prevent more widespread opioid use.
Original languageEnglish
JournalBMJ Quality & Safety
Early online date14 Sep 2021
Publication statusE-pub ahead of print - 14 Sep 2021


  • Hip
  • Knee
  • Arthroplasty
  • Opioids
  • COVID - 19
  • Wait


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