Does Traumatic Brain Injury Increase Opioid Utilization after Primary Total Knee Arthroplasty?

Abstract

Traumatic brain injury (TBI) is a common neurological injury with widespread systemic effects, leading to increased pain and opioid utilization. In this study, we investigated how a prior TBI affects perioperative opioid utilization in patients undergoing a total knee arthroplasty (TKA) as well as the risk of prolonged opioid usage. Using an administrative claims database, we identified patients undergoing a primary TKA from 2010 to 2022. Following inclusion and exclusion criteria, patients were categorized based on a prior diagnosis of a TBI, leading to a final TBI cohort of 127,369 patients and a control cohort of 1,116,605 patients. Our primary outcome was perioperative opioid utilization, defined as any opioid prescription between 30 days before and after surgery. Our secondary outcome was persistent opioid usage, or continued opioid prescriptions 90 to 180 days after surgery. Multivariate regression models were used to assess the risk of persistent opioid usage based on TBI history, adjusting for demographics and comorbidities. Patients who had a prior TBI had greater perioperative opioid utilization compared to patients who did not have a prior TBI, with 987.5 versus 896.7 morphine milligram equivalents (P < 0.001). The TBI cohort also showed greater rates of persistent opioid usage compared to the control cohort: 22,258 patients (17.5%) versus 162,214 patients (14.5%) (P < 0.001). In the multivariate regression analyses, prior diagnosis of a TBI within one year before a TKA was associated with the greatest risk of persistent opioid usage (odds ratio (OR) 1.20, 95% confidence interval (CI): 1.14 to 1.22, P < 0.001). Prior diagnosis of a TBI is associated with greater perioperative opioid utilization and an increased risk of prolonged opioid utilization after a TKA. Further research should investigate the mechanisms of this association to target interventions for this population and ultimately reduce opioid consumption.