Preoperative risk factors: association and limits

Educational work by a pre-medical student — not medical advice. Not a clinical protocol, prescription, or patient handout, and not for patient care. See DISCLAIMER.

Independent educational note, revised 27 October 2026. The earlier unverified prevalence estimates, fixed dose thresholds, screening performance and causal claims are withdrawn.

Goesling et al., 2016, PMID 26871536 prospectively followed a mixed TKA/THA cohort for six months. Preoperative opioid use and other pain-related observations were associated with later opioid use. This does not establish that opioids caused every poor outcome, validate a universal dose threshold, or show that an intraoperative opioid-free regimen prevents persistent use.

Forsythe et al., 2008, PMID 18719716 examines catastrophizing and residual pain after knee arthroplasty. Prognostic associations should not be converted into a diagnosis, blame, a reason to deny surgery, or proof that a particular screening-directed intervention improves outcomes.

Reading questions

1. Is the outcome persistent opioid use, pain, function, satisfaction, or another construct?
2. How were baseline exposure, follow-up use, missing data and confounders defined?
3. Does the study support prediction in a comparable population, or only a group association?
4. Has the proposed risk-modification intervention itself been tested?
5. Could structural disease, mood, sleep, widespread pain, medication effects and access to care overlap?

A questionnaire score is not a diagnosis of opioid-induced hyperalgesia, central sensitization or a psychiatric condition. No opioid taper, medication change, screening cutoff or surgical-eligibility rule is supplied. Questionnaire items and copyrighted instruments are not reproduced.