The Association Between Potential Opioid-Related Adverse Drug Events and Outcomes in Total Knee Arthroplasty: A Retrospective Study

Adv Ther. 2020 Jan;37(1):200-212. doi: 10.1007/s12325-019-01122-1. Epub 2019 Oct 29.


Introduction: Characterization of the clinical and economic impact of opioid-related adverse drug events (ORADEs) after total knee arthroplasty (TKA) may guide provider and hospital system approach to managing postoperative pain after TKA. Our analysis quantifies the rate of potential ORADEs after TKA, the impact of potential ORADEs on length of stay (LOS) and hospital revenue, as well as their association with specific patient risk factors and comorbid clinical conditions.

Methods: We conducted a retrospective study using the Centers for Medicare and Medicaid Services administrative database to analyze Medicare discharges involving two knee replacement surgery diagnosis-related groups (DRGs) in order to identify potential ORADEs. The impact of potential ORADEs on mean hospital LOS and hospital revenue was analyzed.

Results: The potential ORADE rate in patients who underwent TKA was 25,523 out of 316,858 records analyzed (8.0%). The mean LOS for patients who experienced a potential ORADE was 1.04 days longer than those without an ORADE. The mean hospital revenue per day with a potential ORADE was $1334 (USD) less than without an ORADE. Potential ORADEs were significantly associated with poor patient outcomes such as pneumonia, septicemia, and shock.

Conclusion: Potential ORADEs in TKA are associated with longer hospitalizations, decreased hospital revenue, and poor patient outcomes. Certain risk factors may predispose patients to experiencing an ORADE, and thus perioperative pain management strategies that reduce the frequency of ORADEs particularly in at-risk patients can improve patient satisfaction and increase hospital revenue following TKAs.

Keywords: Adverse event; Arthroplasty; Complications; Cost; Joint surgery; Length of stay; Opioids; Total knee arthroplasty.

MeSH terms

  • Aged
  • Analgesics, Opioid / adverse effects*
  • Analgesics, Opioid / therapeutic use
  • Arthroplasty, Replacement, Knee*
  • Databases, Factual
  • Drug-Related Side Effects and Adverse Reactions / epidemiology
  • Female
  • Humans
  • Length of Stay / economics
  • Length of Stay / statistics & numerical data
  • Male
  • Medicare / economics
  • Middle Aged
  • Pain, Postoperative / drug therapy*
  • Retrospective Studies
  • Risk Factors
  • Sepsis / etiology
  • United States


  • Analgesics, Opioid

Associated data

  • figshare/10.6084/m9.figshare.9928940