Older, Heavier, Arthritic, Psychiatrically Disordered, and Opioid-Familiar Patients Are at Risk for Opioid Use After Medial Patellofemoral Ligament Reconstruction

Abstract

Purpose To investigate which factors predispose patients for prolonged opioid use after medial patellofemoral ligament (MPFL) reconstruction. Methods A retrospective review of all patients who underwent MPFL reconstruction at a single institution between January 2013 and June 2020 was conducted. Opioid consumption before and after surgery was recorded and confirmed using Michigan Automated Prescriptions System monitoring program. Patients were classified into preoperative opioid users and nonusers. Risk factors for continued opioid use were assessed by collecting patient demographic variables, psychiatric history, number of previous patellar dislocations, and operative factors. Results A total of 102 patients were included during the time frame of interest. Patients were on average 21.6 ± 8.5 years old with a mean body mass index of 28.2 ± 7.9. Thirty patients (29.0%) sustained >10 dislocations preoperatively. Preoperative opioid use was present in 13 (12.7%) patients. Greater than 10 dislocations (odds ratio [OR] 5.00, 95% confidence interval [CI] 1.12-20.92) and psychiatric history (OR 3.33, 95% CI, 1.2-9.1; P = .016) significantly predicted opioid refills the first month after surgery. Risk factors for opioid refills at 2 to 12 months postoperatively included smoking (OR 4.50, 95% CI 1.13-17.96), preoperative opioid use (OR 7.32, 95% CI 1.88-28.47), psychiatric disorder (OR 3.77, 95% CI 2.3-6.2; P < .001), age >30 years (OR 7.03, 95% CI 3.63-13.61; P < .001), and obesity (OR 2.68, 95% CI 1.40-5.14; P = .002). Compared with Outerbridge 0, a greater percentage of patients with Outerbridge 1 or 2 and 3 or 4 continued using opioids 2 to 12 months after surgery (OR 3.06, 95% CI 1.33-7.02; P = .006 and OR 2.86, 95% CI 1.24-6.59; P = .010, respectively). Conclusions For patients undergoing MPFL reconstruction, preoperative opioid use, cartilage damage, age >30 years, smoking history, body mass index >30, and history of psychiatric disorder were found to be significantly associated with prolonged opioid use after surgery. Postoperative opioid refills in this cohort declined after 1 month. Level of Evidence Level III, retrospective cohort study.

Cultural Competence and the Postoperative Experience: Pain Control and Rehabilitation

“…Risk factors including male sex, increased body mass index, chronic preoperative opioid use, and history of anxiety/depression have been established for opioid use in pain management and length of postoperative opioid use. 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 A prospective study of 250 patients (36 Black patients, 100 Hispanic patients, and 114 white patients) after open reduction and internal fixation of limb fractures by Ng et al. 37 found that Black and Hispanic patients received lower-dose analgesics during their hospitalization (average LOS of 4.45 days) than white patients (Black: 16 mg/day, Hispanic: 13 mg/day, white: 22 mg/day, P < .002).…”

Risk Factors Associated With Prolonged Opioid Use After Revision Total Shoulder Arthroplasty

“…1 Between 2000 and 2017, accidental deaths due to opioid use increased from 2.2 to 13.2 deaths per 100,000 people. 2 In particular, orthopaedic surgeons prescribe opioids at high rates. 2,3 There have been multiple studies that have investigated risk factors of opioid use after orthopaedic procedures, such as anterior cruciate ligament reconstruction, 4 meniscal surgery, 5 and hip/knee arthroplasty.…”

“…2 In particular, orthopaedic surgeons prescribe opioids at high rates. 2,3 There have been multiple studies that have investigated risk factors of opioid use after orthopaedic procedures, such as anterior cruciate ligament reconstruction, 4 meniscal surgery, 5 and hip/knee arthroplasty. 6 Total shoulder arthroplasty (TSA) is a common orthopaedic procedure, with several advancements over the years.…”

Older Age, Female Sex, Anxiety, Substance Use Disorder, Osteoarthritis, Tibial Tubercle Osteotomy, and Opioid Familiarity Are Risk Factors for Prolonged Opioid Use Following Medial Patellofemoral Ligament Reconstruction

“… 1 Although multiple providers in various medical specialties prescribe opioids, orthopaedic surgeons do so at one of the highest rates. 1 , 2 , 3 Orthopaedic patients also have a high prescription refill rate compared with other specialties. 2 Okoli et al.…”

“… 1 , 2 , 3 Orthopaedic patients also have a high prescription refill rate compared with other specialties. 2 Okoli et al. 4 analyzed postoperative opioid use after common outpatient orthopaedic surgeries at a single institution, some of which being rotator cuff repair, anterior cruciate ligament reconstruction (ACLR), and Achilles tendon repair, finding that more than 11% of patients continued using opioids after 6 months.…”