Opioid Use Disorder as a Perioperative Safety Risk in Elective Total Hip Arthroplasty: A Nationwide Matched Analysis and Rationale for Routine Preoperative Screening

Background :Total hip arthroplasty (THA) utilization is rising worldwide, but the concurrent opioid epidemic has introduced new perioperative safety challenges. Opioid use disorder (OUD) is a chronic relapsing condition that may complicate surgical management and increase preventable adverse events. Methods :We performed a retrospective cohort study using the National Inpatient Sample (NIS) 2016–2022. Adult patients undergoing primary THA were identified by ICD-10 procedural codes, and OUD was identified by ICD-10-CM code F11.x. Cases performed for hip fracture or revision surgery were excluded to focus on primary osteoarthritis cases. Patients with any documented COVID-19 infection (identified via ICD-10 diagnosis codes) were also excluded to eliminate the influence of COVID-related complications. Patients with OUD were propensity score–matched 1:1 to non-OUD patients based on demographics, comorbidities, and payer status. Outcomes assessed included length of stay (LOS), total hospital charges, and in-hospital postoperative Complications. Results :1.9 million THA cases were identified nationwide, of which 0.6had a diagnosis of OUD. After matching, baseline characteristics were comparable. OUD prevalence in THA increased over time, from 0.53% in 2016 to 0.97% in 2022. Patients with OUD had a significantly longer mean LOS (p < 0.001) and higher mean hospital charges (~ 15% higher, p < 0.001) compared to non-OUD patients. OUD was associated with higher complication. Conclusions :Patients with OUD undergoing THA experience significantly worse inpatient outcomes and higher costs. These findings highlight OUD as a modifiable surgical-safety risk factor and support the implementation of routine preoperative OUD screening and optimization protocols to improve patient safety and resource utilization.