Opioid Consumption After Knee Arthroscopy

Abstract

Background: The opioid epidemic in the United States has placed increased pressure on physicians to engage in responsible opioid prescribing practices. However, surgeons currently have little information to guide their postoperative prescription decision-making. The purpose of this study was to assess opioid consumption after knee arthroscopy and identify preoperative factors that may predict higher opioid usage.Methods: A prospective observational study of 221 patients was conducted in patients undergoing outpatient knee arthroscopy for meniscal repair, partial meniscectomy, debridement, chondroplasty, or loose body removal. Participants recorded their daily opioid consumption in a postoperative pain diary. Total opioid consumption was calculated from counts of remaining pills at the 2-week and 6-week postoperative office visits. Variables, including age, sex, body mass index, smoking status, alcohol consumption, preoperative pain severity and duration, preoperative opioid usage, Patient-Reported Outcomes Measurement Information System (PROMIS) scores, and the Connor-Davidson Resilience Scale, were evaluated for an association with opioid consumption.Results: Total opioid consumption ranged from 0 to 188 pills, with a median of 7 pills (hydrocodone 5-mg equivalents).Forty-six percent of patients took £5 pills, 59% took £10 pills, and 81% took £20 pills. Fifty-six percent of patients had discontinued opioid usage by the third postoperative day. Eighty-eight percent of patients had surplus opioid medication at the time of the final follow-up. Patients undergoing meniscal repair, smokers, and those taking preoperative opioids were significantly more likely to take ‡20 pills (p < 0.05). Conclusions:The median number of pills taken after knee arthroscopy is 7, with the majority of patients consuming £20 pills. Meniscal repair, smoking, and preoperative opioid usage were associated with higher postoperative opioid consumption.Level of Evidence: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Opioid Requirement following Arthroscopic Knee Surgery: Are There Predictive Factors Associated with Long-Term Use

“…Interestingly, although several studies have found an association between preoperative narcotic use and higher postoperative narcotic use, the current study did not find a significant difference in total opioid consumption based on preoperative opioid use. 5,7,14 An explanation for this result could be the relatively small sample size of patients with regular opioid use in the current study. A majority of patients were acutely exposed to opioids within 30 days of their surgery and only one patient chronically used opioids.…”

“…[3][4][5] In a prospective observational study, Wojahn et al found that nearly half of their patients used less than 5 pills following knee arthroscopy, and over half had discontinued opioid use by postoperative day 3. 5 The study did not include knee procedures involving ligament reconstruction. When accounting for this difference in procedures, the current study 3 Additionally, the authors found a lack of patient knowledge and education regarding opioid disposal.…”

“…Wojahn et al similarly found that patient resiliency (measured by the Connor-Davidson scale) and preoperative patient outcome scores (Patient-Reported Outcomes Measurement Information System) were not associated with postoperative opioid use. 5 Again, these discrepancies highlight the complexity of psychosocial factors on opioid use. The results of the current study suggest that pain catastrophizing plays a larger role in postoperative opioid consumption than resiliency or patientreported functional scores.…”

Opioid-limiting legislation associated with decreased 30-day opioid utilization following anterior cervical decompression and fusion

“…Patient factors appear more important than legislative or surgical factors for predicting chronic opioid use. Multiple studies have previously evaluated risk-factors for prolonged or chronic opioid use following musculoskeletal surgery [16][17][18][19]23,34,36,39,40]. As in this study, the most commonly cited risk factor is preoperative opioid use.…”

“…Although providers previously may have overprescribed opioids for fear of inadequate postoperative pain control, it appears that a 150 MME prescription following ACDF is generally sufficient. A number of studies have found that orthopedic patients routinely receive more postoperative opioids than required to control their pain [26,27,33,34]. Such overprescribing results in unused pills and diversion of narcotics, a primary driving force behind prescription opioid abuse [28].…”