Patient Perceptions Towards Reduction or Avoidance of Opioids After Knee and Hip Arthroplasty: A Cross-Sectional Survey

Background and objective Opioid analgesics are routinely prescribed to manage pain after total joint arthroplasty (TJA) but are associated with several adverse effects. There is a scarcity of literature exploring patients' receptivity, attitudes, and perceptions towards opioid-sparing postoperative protocols. In light of this, we conducted this study to address those gaps in the literature. Methods We administered a cross-sectional survey to patients aged 18 years or older who were attending either a preoperative or a postoperative TJA appointment, up to 12 months after surgery. We aimed to determine the proportion of patients who would be open to receiving opioid-free or opioid-reduced postoperative care, identify patient characteristics associated with receptivity, and determine patients' perceptions regarding the efficacy and safety of opioids. We constructed multivariable logistic regression models to explore features associated with patients' receptivity to opioid reduction or avoidance. Results We approached 200 patients, and 190 returned a complete survey. A quarter of respondents believed that other analgesics were similarly effective or superior to opioids, and 68% perceived that opioids were associated with more side effects than alternatives. Of note, 50% of patients indicated that they would be receptive to reduced opioid use postoperatively. Patients' receptivity was associated with not using opioids at the time of survey completion [odds ratio (OR): 2.5, 95% confidence interval (CI): 1.04-6.4), and the belief that opioids had more side effects than alternatives (OR: 3.4, 95% CI: 1.5-7.9); 40% of respondents indicated they would be willing to avoid opioid use after surgery, and receptivity was associated with the belief that opioids cause more side effects than alternatives (OR: 4.3, 95% CI: 1.8-11.9) and that non-opioid analgesics are similarly or more effective (OR: 3.4, 95% CI: 1.4-8.3). Conclusions Many participants were willing to reduce or avoid the use of postoperative opioids, and receptivity was strongly associated with beliefs regarding the comparative benefits and harms of alternatives. These findings suggest opportunities to reduce the use of opioids after TJA and enhance patient education to address misconceptions.