{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T22:30:00Z","timestamp":1789165800152,"version":"build-2803163510"},"reference-count":35,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"16","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2021,8,18]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Opioids are commonly prescribed for postoperative pain following total joint arthroplasty. Despite widespread use, few studies have examined the dose-dependent effect of perioperative opioid use on postoperative complications following total hip arthroplasty (THA) and total knee arthroplasty (TKA). Therefore, we examined the dose-dependent relationship between opioid use and postoperative complications following primary THA and TKA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We queried the Premier Healthcare Database to identify adult patients who underwent primary elective THA or TKA from 2004 to 2014, and quantified opioid consumption within the first 3 postoperative days. Opioid consumption was standardized to morphine milligram equivalents (MMEs). Patients were divided into quintiles on the basis of MME exposure: &lt;54, 54 to 82, 83 to 116, 117 to 172, and &gt;172 MMEs. Primary outcomes included postoperative periprosthetic joint infection, pulmonary embolism, deep venous thrombosis, and pulmonary complications. Secondary outcomes included wound infection, wound dehiscence, and readmission within 30 and 90 days postoperatively. Univariate and multivariate analyses were performed to compare differences between groups and to account for confounders.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>A total of 1,525,985 patients were identified. The mean age was 65.7 \u00b1 10.8 years, 598,320 patients (39.2%) were male, and 1,174,314 patients (77.0%) were Caucasian. On multiple logistic regression analysis, increasing MME exposure was associated with a dose-dependent increased risk of postoperative complications. Compared with patients receiving &lt;54 MMEs, exposure to &gt;172 MMEs was associated with greater odds of periprosthetic joint infection (adjusted odds ratio [aOR], 1.37; 95% confidence interval [CI], 1.33 to 1.42), deep venous thromboembolism (aOR, 1.34; 95% CI, 1.30 to 1.38), pulmonary embolism (aOR, 1.29; 95% CI, 1.25 to 1.34), and pulmonary complications (aOR, 1.06; 95% CI, 1.05 to 1.08). Exposure to &gt;172 MMEs was associated with increased risk of wound infection (aOR, 1.37; 95% CI, 1.33 to 1.41), wound dehiscence (aOR, 1.24; 95% CI, 1.19 to 1.31), and readmission within 30 (aOR, 1.21; 95% CI, 1.20 to 1.22) and 90 days (aOR, 1.20; 95% CI, 1.19 to 1.21).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Increasing opioid use within the early postoperative period following THA or TKA was associated with a dose-dependent increased risk of periprosthetic joint infection and venous thromboembolic events.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Therapeutic\n                      <jats:underline>Level IV<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.21.00045","type":"journal-article","created":{"date-parts":[[2021,5,27]],"date-time":"2021-05-27T15:01:45Z","timestamp":1622127705000},"page":"1531-1542","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":29,"title":["Dose-Dependent Early Postoperative Opioid Use Is Associated with Periprosthetic Joint Infection and Other Complications in Primary TJA"],"prefix":"10.2106","volume":"103","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7979-934X","authenticated-orcid":false,"given":"Brian C.","family":"Chung","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2993-3205","authenticated-orcid":false,"given":"Gabriel J.","family":"Bouz","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5268-3817","authenticated-orcid":false,"given":"Cory K.","family":"Mayfield","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8633-8023","authenticated-orcid":false,"given":"Haley","family":"Nakata","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0447-5762","authenticated-orcid":false,"given":"Alexander B.","family":"Christ","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5678-2510","authenticated-orcid":false,"given":"Daniel A.","family":"Oakes","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1374-8929","authenticated-orcid":false,"given":"Jay R.","family":"Lieberman","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1293-1702","authenticated-orcid":false,"given":"Nathanael D.","family":"Heckmann","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2021,5,27]]},"reference":[{"issue":"4","key":"bib1-20250430","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1001\/jama.284.4.423b","article-title":"JCAHO pain management standards are unveiled","volume":"284","author":"Phillips","year":"2000","journal-title":"JAMA."},{"issue":"1","key":"bib2-20250430","first-page":"10","article-title":"CDC grand rounds: prescription drug overdoses - a U.S. epidemic","volume":"61","author":"Centers for Disease Control and Prevention (CDC)","year":"2012","journal-title":"MMWR Morb Mortal Wkly Rep."},{"issue":"1","key":"bib3-20250430","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1016\/j.jpain.2005.08.001","article-title":"Opioid tolerance and hyperalgesia in chronic pain patients after one month of oral morphine therapy: a preliminary prospective study","volume":"7","author":"Chu","year":"2006","journal-title":"J Pain."},{"issue":"3","key":"bib4-20250430","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1054\/jpai.2002.123652","article-title":"Adverse events associated with postoperative opioid analgesia: a systematic review","volume":"3","author":"Wheeler","year":"2002","journal-title":"J Pain."},{"issue":"5","key":"bib5-20250430","doi-asserted-by":"crossref","first-page":"267","DOI":"10.5435\/JAAOS-D-14-00163","article-title":"The opioid epidemic: impact on orthopaedic surgery","volume":"23","author":"Morris","year":"2015","journal-title":"J Am Acad Orthop Surg."},{"issue":"3","key":"bib6-20250430","doi-asserted-by":"crossref","first-page":"ES9","DOI":"10.36076\/ppj.2012\/15\/ES9","article-title":"Opioid epidemic in the United States","volume":"15","author":"Manchikanti","year":"2012","journal-title":"Pain Physician."},{"issue":"13","key":"bib7-20250430","doi-asserted-by":"crossref","first-page":"1299","DOI":"10.1001\/jama.2011.401","article-title":"Characteristics of opioid prescriptions in 2009","volume":"305","author":"Volkow","year":"2011","journal-title":"JAMA."},{"issue":"4","key":"bib9-20250430","doi-asserted-by":"crossref","first-page":"674","DOI":"10.1111\/jgs.15767","article-title":"American Geriatrics Society 2019 updated AGS Beers Criteria\u00ae for potentially inappropriate medication use in older adults","volume":"67","year":"2019","journal-title":"J Am Geriatr Soc."},{"issue":"Suppl 1","key":"bib10-20250430","doi-asserted-by":"crossref","first-page":"S12","DOI":"10.1097\/BOT.0000000000000563","article-title":"Use of nonopioid analgesics and the impact on patient outcomes","volume":"30","author":"Sanzone","year":"2016","journal-title":"J Orthop Trauma."},{"issue":"1","key":"bib11-20250430","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1016\/j.arth.2017.08.006","article-title":"Narcotic use and total knee arthroplasty","volume":"33","author":"Cancienne","year":"2018","journal-title":"J Arthroplasty."},{"issue":"10","key":"bib12-20250430","doi-asserted-by":"crossref","first-page":"3246","DOI":"10.1016\/j.arth.2018.05.027","article-title":"Preoperative opioids increase the risk of periprosthetic joint infection after total joint arthroplasty","volume":"33","author":"Bell","year":"2018","journal-title":"J Arthroplasty."},{"issue":"6S","key":"bib13-20250430","doi-asserted-by":"crossref","first-page":"S237","DOI":"10.1016\/j.arth.2020.02.014","article-title":"The effects of opioid use on thromboembolic complications, readmission rates, and 90-day episode of care costs after total hip arthroplasty","volume":"35","author":"Sodhi","year":"2020","journal-title":"J Arthroplasty."},{"issue":"7","key":"bib14-20250430","doi-asserted-by":"crossref","first-page":"2402","DOI":"10.1007\/s11999-015-4173-5","article-title":"Preoperative opioid misuse is associated with increased morbidity and mortality after elective orthopaedic surgery","volume":"473","author":"Menendez","year":"2015","journal-title":"Clin Orthop Relat Res."},{"issue":"1","key":"bib15-20250430","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1186\/s12891-019-2619-8","article-title":"Preoperative opioid use is associated with worse patient outcomes after Total joint arthroplasty: a systematic review and meta-analysis","volume":"20","author":"Goplen","year":"2019","journal-title":"BMC Musculoskelet Disord."},{"issue":"9","key":"bib16-20250430","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1016\/j.arth.2016.02.068","article-title":"Long-acting opioid use independently predicts perioperative complication in total joint arthroplasty","volume":"31","author":"Sing","year":"2016","journal-title":"J Arthroplasty."},{"issue":"1","key":"bib17-20250430","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1016\/j.jcot.2019.04.027","article-title":"The effects of preoperative chronic opioid use in total hip arthroplasty","volume":"11","author":"Kim","year":"2020","journal-title":"J Clin Orthop Trauma."},{"issue":"Suppl 1","key":"bib18-20250430","doi-asserted-by":"crossref","first-page":"s9","DOI":"10.1191\/0269216306pm1124oa","article-title":"Opioids and the immune system","volume":"20","author":"Sacerdote","year":"2006","journal-title":"Palliat Med."},{"issue":"4","key":"bib19-20250430","doi-asserted-by":"crossref","first-page":"442","DOI":"10.1007\/s11481-011-9292-5","article-title":"Opioid drug abuse and modulation of immune function: consequences in the susceptibility to opportunistic infections","volume":"6","author":"Roy","year":"2011","journal-title":"J Neuroimmune Pharmacol."},{"issue":"1","key":"bib20-20250430","first-page":"5","article-title":"Opioid system modulates the immune function: a review","volume":"1","author":"Liang","year":"2016","journal-title":"Transl Perioper Pain Med."},{"issue":"11","key":"bib21-20250430","doi-asserted-by":"crossref","first-page":"1375","DOI":"10.1007\/BF02532379","article-title":"Effects of opioids on the immune system","volume":"21","author":"Roy","year":"1996","journal-title":"Neurochem Res."},{"issue":"1","key":"bib22-20250430","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1007\/s11481-005-9009-8","article-title":"Modulation of immune function by morphine: implications for susceptibility to infection","volume":"1","author":"Roy","year":"2006","journal-title":"J Neuroimmune Pharmacol."},{"key":"bib23-20250430","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1186\/1744-8069-3-28","article-title":"Morphine reduces local cytokine expression and neutrophil infiltration after incision","volume":"3","author":"Clark","year":"2007","journal-title":"Mol Pain."},{"issue":"1","key":"bib24-20250430","first-page":"17","article-title":"Comparison between homocysteine, fibrinogen, PT, PTT, INR and CRP in male smokers with\/without addiction to opium","volume":"9","author":"Azdaki","year":"2017","journal-title":"Addict Health."},{"issue":"37","key":"bib25-20250430","doi-asserted-by":"crossref","first-page":"5994","DOI":"10.2174\/138161212803582469","article-title":"Non-analgesic effects of opioids: opioid-induced respiratory depression","volume":"18","author":"Boom","year":"2012","journal-title":"Curr Pharm Des."},{"issue":"1","key":"bib26-20250430","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1007\/s12016-013-8373-z","article-title":"The effects of opioids on the lung","volume":"46","author":"Radke","year":"2014","journal-title":"Clin Rev Allergy Immunol."},{"issue":"6","key":"bib27-20250430","doi-asserted-by":"crossref","first-page":"626","DOI":"10.1097\/MLR.0b013e31819432e5","article-title":"A modification of the Elixhauser comorbidity measures into a point system for hospital death using administrative data","volume":"47","author":"van Walraven","year":"2009","journal-title":"Med Care."},{"issue":"1-2","key":"bib28-20250430","first-page":"9","article-title":"A review on hematological factors in opioid-dependent people (opium and heroin) after the withdrawal period","volume":"2","author":"Haghpanah","year":"2010","journal-title":"Addict Health."},{"issue":"2","key":"bib29-20250430","doi-asserted-by":"crossref","first-page":"S105","DOI":"10.36076\/ppj.2008\/11\/S105","article-title":"Opioid complications and side effects","volume":"11","author":"Benyamin","year":"2008","journal-title":"Pain Physician."},{"issue":"19","key":"bib30-20250430","doi-asserted-by":"crossref","first-page":"1331","DOI":"10.1097\/BRS.0000000000002609","article-title":"Preoperative chronic opioid therapy: a risk factor for complications, readmission, continued opioid use and increased costs after one- and two-level posterior lumbar fusion","volume":"43","author":"Jain","year":"2018","journal-title":"Spine."},{"issue":"2","key":"bib31-20250430","doi-asserted-by":"crossref","first-page":"786","DOI":"10.2353\/ajpath.2010.090457","article-title":"Chronic morphine administration delays wound healing by inhibiting immune cell recruitment to the wound site","volume":"176","author":"Martin","year":"2010","journal-title":"Am J Pathol."},{"issue":"2","key":"bib32-20250430","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1016\/j.cellimm.2010.08.002","article-title":"Chronic morphine treatment inhibits LPS-induced angiogenesis: implications in wound healing","volume":"265","author":"Martin","year":"2010","journal-title":"Cell Immunol."},{"issue":"4","key":"bib33-20250430","doi-asserted-by":"crossref","first-page":"345","DOI":"10.1097\/01.ajp.0000125244.29279.c1","article-title":"The effect of opioids on driving and psychomotor performance in patients with chronic pain","volume":"21","author":"Byas-Smith","year":"2005","journal-title":"Clin J Pain."},{"issue":"12","key":"bib34-20250430","doi-asserted-by":"crossref","first-page":"2422","DOI":"10.1097\/j.pain.0000000000001047","article-title":"Opioid prescription levels and postoperative outcomes in orthopedic surgery","volume":"158","author":"Cozowicz","year":"2017","journal-title":"Pain."},{"issue":"1","key":"bib35-20250430","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1097\/00005650-199401000-00006","article-title":"Bias in the coding of hospital discharge data and its implications for quality assessment","volume":"32","author":"Romano","year":"1994","journal-title":"Med Care."},{"issue":"24","key":"bib36-20250430","doi-asserted-by":"crossref","first-page":"2019","DOI":"10.1097\/BRS.0000000000000598","article-title":"Administrative database concerns: accuracy of International Classification of Diseases, Ninth Revision coding is poor for preoperative anemia in patients undergoing spinal fusion","volume":"39","author":"Golinvaux","year":"2014","journal-title":"Spine."}],"container-title":["Journal of Bone and Joint Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.21.00045","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:47:31Z","timestamp":1787752051000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.21.00045"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,5,27]]},"references-count":35,"journal-issue":{"issue":"16","published-print":{"date-parts":[[2021]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.21.00045","relation":{},"ISSN":["0021-9355","1535-1386"],"issn-type":[{"value":"0021-9355","type":"print"},{"value":"1535-1386","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,5,27]]}}}