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Table 4 Preoperative opioid use definitional parameters

From: Preoperative opioid use is associated with worse patient outcomes after Total joint arthroplasty: a systematic review and meta-analysis

Study

Definition of Opioid User

Justification

Opioid Use

Source of Pharmacy Data

Included Opioids

Preoperative Duration

Preoperative Dose (MED)

Zywiel et al.

Any documented opioid use (minimum ≥20 mg morphine equivalents per day) for minimum 6 weeks prior to index procedure

Chu et al (2006)

N/A

Prescription records, clinic notes and admission records

N/A

Minimum 6 weeks

58 mg

Smith et al.

At least 1 opioid prescription within 2 years of index surgery

N/A

23%

Clinical visit notes, anesthesiology reports, discharge notes, prescription history, and medication lists.

Oxycodone, hydrocodone, hydromorphone, morphine, tramadol, codeine

N/A

N/A

Franklin et al.

Any documented opioid prescription prior to index procedure

N/A

24%

Administrative Database

Percocet, Vicodin, Darvocet, Tylenol with codeine

‘other’

N/A

N/A

Pivec et al.

Minimum of 6 weeks of narcotic use (minimum ≥30 mg morphine equivalents per day) prior to index TKA

Chu et al (2006)

N/A

Clinic charts, in-patient hospital medication administration records, prescription documentation, and phone interviews

Morphine, codeine, hydrocodone, hydromorphone, methadone, meperidine, oxycodone, propoxyphene, tramadol, transdermal fentanyl

Minimum 6 weeks

N/A

Nguyen et al.

Continuous opioid use for at least 4 weeks prior to index procedure

Chu et al (2006)

N/A

Clinic and referral notes

N/A

Minimum 4 weeks

a Low 34%

Medium 17%

High 15%

Very High 34%

Goesling et al.

Patient-reported opioids use prior to index procedure

N/A

29%

Chart review, confirmed by patient

N/A

N/A

N/A

 

Mean b

24%

 
  1. Abbreviations
  2. N/A, data not available, MED Morphine equivalent dose
  3. Notes
  4. aClassification of opioid user: Low (< 30 mg), Medium (31–60 mg) High (61 - 120 mg) and Very High (> 121 mg).
  5. bMean calculated by summing number of patients prescribed preoperative opioids (n = 1747) and dividing by total patients (n = 7163).
  6. Chu et al. (2006) – minimum duration and dosage required of morphine required to develop opioid induced hyperalgesia