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The impact of preoperative tramadol-only use on outcomes following total knee arthroplasty - Is tramadol different than traditional opioids?

Publication ,  Journal Article
Wilson, JM; Schwartz, AM; Farley, KX; Erens, GA; Bradbury, TL; Guild, GN
Published in: Knee
January 2021

BACKGROUND: Opioid use prior to total knee arthroplasty (TKA) is known to have detrimental influence on postoperative outcomes. Whether or not the same is true for tramadol is currently unclear. The aim of this study was to clarify the relationship between preoperative tramadol and postoperative complications. METHODS: The Truven Marketscan® Databases were used to conduct this retrospective cohort study. Patients undergoing primary TKA were identified and divided into cohorts based on preoperative medication status (i.e. opioid naïve, tramadol-only, or non-tramadol opioids). Patient demographics, comorbidities, and 90-day outcomes were collected and compared between cohorts. Revision rates were analyzed at 1- and 3-years postoperatively. Univariate and multivariate analysis was performed. RESULTS: 336,316 patients were included and 23,097 (6.9%) were preoperative tramadol-only users. Tramadol-only patients (v. opioid naïve) had increased odds of 90-day readmission (OR-1.07, 95%CI 1.02-1.12, p = 0.004), wound complication (OR-1.13, 95%CI 1.01-1.27, p = 0.34), and 3-year revision rates (OR-1.35, 95%CI 1.19-1.53, p < 0.001). However, when compared to the preoperative opioid cohorts, tramadol-only patients had decreased odds of nearly all outcomes. Over the study period, the number of patients receiving preoperative opioids decreased while the proportion of patients prescribed tramadol-only increased. CONCLUSIONS: While tramadol-only use has lower risk than traditional opioids, tramadol-only use preceding TKA is associated with increased rates of readmission, wound complication and revision surgery. This is important information for prescribers who may be using tramadol to treat symptomatic knee arthrosis prior to arthroplasty referral and for thought leaders producing clinical practice guidelines. LEVEL OF EVIDENCE: Level III, Prognostic.

Duke Scholars

Published In

Knee

DOI

EISSN

1873-5800

Publication Date

January 2021

Volume

28

Start / End Page

131 / 138

Location

Netherlands

Related Subject Headings

  • Tramadol
  • Risk Factors
  • Retrospective Studies
  • Reoperation
  • Preoperative Care
  • Pain, Postoperative
  • Osteoarthritis, Knee
  • Orthopedics
  • Middle Aged
  • Male
 

Citation

APA
Chicago
ICMJE
MLA
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Wilson, J. M., Schwartz, A. M., Farley, K. X., Erens, G. A., Bradbury, T. L., & Guild, G. N. (2021). The impact of preoperative tramadol-only use on outcomes following total knee arthroplasty - Is tramadol different than traditional opioids? Knee, 28, 131–138. https://doi.org/10.1016/j.knee.2020.11.003
Wilson, Jacob M., Andrew M. Schwartz, Kevin X. Farley, Greg A. Erens, Thomas L. Bradbury, and George N. Guild. “The impact of preoperative tramadol-only use on outcomes following total knee arthroplasty - Is tramadol different than traditional opioids?Knee 28 (January 2021): 131–38. https://doi.org/10.1016/j.knee.2020.11.003.
Wilson JM, Schwartz AM, Farley KX, Erens GA, Bradbury TL, Guild GN. The impact of preoperative tramadol-only use on outcomes following total knee arthroplasty - Is tramadol different than traditional opioids? Knee. 2021 Jan;28:131–8.
Wilson, Jacob M., et al. “The impact of preoperative tramadol-only use on outcomes following total knee arthroplasty - Is tramadol different than traditional opioids?Knee, vol. 28, Jan. 2021, pp. 131–38. Pubmed, doi:10.1016/j.knee.2020.11.003.
Wilson JM, Schwartz AM, Farley KX, Erens GA, Bradbury TL, Guild GN. The impact of preoperative tramadol-only use on outcomes following total knee arthroplasty - Is tramadol different than traditional opioids? Knee. 2021 Jan;28:131–138.
Journal cover image

Published In

Knee

DOI

EISSN

1873-5800

Publication Date

January 2021

Volume

28

Start / End Page

131 / 138

Location

Netherlands

Related Subject Headings

  • Tramadol
  • Risk Factors
  • Retrospective Studies
  • Reoperation
  • Preoperative Care
  • Pain, Postoperative
  • Osteoarthritis, Knee
  • Orthopedics
  • Middle Aged
  • Male