{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T19:21:11Z","timestamp":1790709671444,"version":"4.1.0"},"reference-count":74,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"\n Background:<\/jats:title>\n The purpose of this comprehensive review was to investigate risk factors associated with prolonged opioid use after orthopaedic procedures. A comprehensive review of the opioid literature may help to better guide preoperative management of expectations as well as opioid-prescribing practices.<\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n A systematic review of all studies pertaining to opioid use in relation to orthopaedic procedures was conducted using the MEDLINE, Embase, and CINAHL databases. Data from studies reporting on postoperative opioid use at various time points were collected. Opioid use and risk of prolonged opioid use were subcategorized by subspecialty, and aggregate data for each category were calculated.<\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n There were a total of 1,445 eligible studies, of which 45 met inclusion criteria. Subspecialties included joint arthroplasty, spine, trauma, sports, and hand surgery. A total of 458,993 patients were included, including 353,330 (77%) prolonged postoperative opioid users and 105,663 (23%) non-opioid users. Factors associated with prolonged postoperative opioid use among all evaluated studies included body mass index (BMI) of \u226540 kg\/m\n 2<\/jats:sup>\n (relative risk [RR], 1.06 to 2.32), prior substance abuse (RR, 1.08 to 3.59), prior use of other medications (RR, 1.01 to 1.46), psychiatric comorbidities (RR, 1.08 to 1.54), and chronic pain conditions including chronic back pain (RR, 1.01 to 10.90), fibromyalgia (RR, 1.01 to 2.30), and migraines (RR, 1.01 to 5.11). Age cohorts associated with a decreased risk of prolonged postoperative opioid use were those \u226531 years of age for hand procedures (RR, 0.47 to 0.94), \u226550 years of age for total hip arthroplasty (RR, 0.70 to 0.80), and \u226570 years of age for total knee arthroplasty (RR, 0.40 to 0.80). Age cohorts associated with an increased risk of prolonged postoperative opioid use were those \u226550 years of age for sports procedures (RR, 1.11 to 2.57) or total shoulder arthroplasty (RR, 1.26 to 1.40) and those \u226570 years of age for spine procedures (RR, 1.61). Identified risk factors for postoperative use were similar across subspecialties.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions:<\/jats:title>\n We provide a comprehensive review of the various preoperative and postoperative risk factors associated with prolonged opioid use after elective and nonelective orthopaedic procedures. Increased BMI, prior substance abuse, psychiatric comorbidities, and chronic pain conditions were most commonly associated with prolonged postoperative opioid use. Careful consideration of elective surgical intervention for painful conditions and perioperative identification of risk factors within each patient\u2019s biopsychosocial context will be essential for future modulation of physician opioid-prescribing patterns.<\/jats:p>\n <\/jats:sec>\n \n Level of Evidence:<\/jats:title>\n \n Prognostic\n 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.rvw.19.00154","type":"journal-article","created":{"date-parts":[[2020,6,8]],"date-time":"2020-06-08T19:06:21Z","timestamp":1591643181000},"page":"e0154-e0154","source":"Crossref","is-referenced-by-count":31,"title":["Factors Predictive of Prolonged Postoperative Narcotic Usage Following Orthopaedic Surgery"],"prefix":"10.2106","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1197-747X","authenticated-orcid":false,"given":"Ophelie","family":"Lavoie-Gagne","sequence":"first","affiliation":[{"name":"Midwest Orthopaedics at Rush, Rush University, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6170-7769","authenticated-orcid":false,"given":"Benedict U.","family":"Nwachukwu","sequence":"additional","affiliation":[{"name":"HSS Sports Medicine Institute West Side, Hospital for Special Surgery, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0346-4735","authenticated-orcid":false,"given":"Answorth A.","family":"Allen","sequence":"additional","affiliation":[{"name":"HSS Sports Medicine Institute West Side, Hospital for Special Surgery, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5417-2372","authenticated-orcid":false,"given":"Timothy","family":"Leroux","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5581-4464","authenticated-orcid":false,"given":"Yining","family":"Lu","sequence":"additional","affiliation":[{"name":"Midwest Orthopaedics at Rush, Rush University, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1665-5872","authenticated-orcid":false,"given":"Brian","family":"Forsythe","sequence":"additional","affiliation":[{"name":"Midwest Orthopaedics at Rush, Rush University, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2020,6]]},"reference":[{"issue":"5152","key":"r1-20230807","doi-asserted-by":"crossref","first-page":"1419","DOI":"10.15585\/mmwr.mm675152e1","article-title":"Drug and opioid-involved overdose deaths \u2013 United States, 2013-2017","volume":"67","author":"Scholl","year":"2018","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"2","key":"r3-20230807","doi-asserted-by":"crossref","first-page":"e187621","DOI":"10.1001\/jamanetworkopen.2018.7621","article-title":"Prevention of prescription opioid misuse and projected overdose deaths in the United States","volume":"2","author":"Chen","year":"2019","journal-title":"JAMA Netw Open"},{"issue":"4","key":"r4-20230807","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1093\/pm\/pnx048","article-title":"Are prescription opioids driving the opioid crisis? 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