Impact of opioid use disorder as a safety risk in elective total hip arthroplasty: an imperative for routine preoperative screening

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. During the study period from January 1, 2016 to December 31, 2022, a total of 1,957,284 elective primary THA cases were identified in the National Inpatient Sample. Of these, 12,285 (0.6%) had a documented diagnosis of opioid use disorder (OUD). After 1:1 propensity score matching, 12,285 OUD cases were matched to 12,285 non-OUD controls with comparable baseline characteristics. Patients with OUD had significantly longer mean length of stay (p < 0.001), higher hospital charges (approximately 15% higher, p < 0.001), and increased rates of in-hospital postoperative complications compared with matched controls. 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.