Preoperative opioid use and complications X-ref Multiple studies have been published evaluating the effect of preoperative opioid use and postoperative outcomes. It will come as no surprise to any reader of 360, given the North American opioid crisis and the subsequent column inches in all journals given up to this dramatic problem, that research has now turned not only to quantifying the problem, but ascertaining what the potential risks in the surgical patient are. The majority of these previous investigations have defined preoperative use as any opioid consumption within one year prior to surgery, which is unlikely to be appropriate to drawing rigorous conclusions. Furthermore, there is as yet no evidence correlating the number and duration of opioids used and potential postoperative complications. To clarify this tumultuous situation, a group from Columbus, Ohio (USA) has investigated preoperative opiate use prior to large joint arthro-plasty and lumbar fusion and correlated it to postoperative complications.1 This group used national insurance claims data between 2007 and 2015 to identify their cohort of 58 082 primary total knee arthroplasties (TKAs), total hip arthroplasties (THAs), and single- or two-level posterior lumbar fusions (PLFs) carried out to treat spondylosis. The group then divided preoperative opioid use into three categories (naive, three months or less, three to six months, more than six months but stopped three months before surgery, and more than six months of continuous use) and, by using these categorized outcomes, set out to establish if there was a link between opioid use and duration with adverse surgical outcomes.
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