Preoperative Opioid Use in Knee Surgery Patients

Abstract

A cross-sectional analysis of data derived from patients undergoing knee surgery at a single institution was conducted. The objectives of the study were to determine the demographic, diagnostic, and psychologic factors associated with opioid use; and to determine the clinical correlates of opioid use. We hypothesized that preoperative opioid use would be associated with worse patient-reported outcome (PRO) measures. The sample consisted of 383 patients undergoing knee surgery. The patients were classified as either opioid or nonopioid users on the basis of medical record review. All participants completed a battery of clinical assessments, including the Patient-Reported Outcomes Measurement Information System computer adaptive testing in six domains: Physical Function, Pain Interference, Fatigue, Social Satisfaction, Anxiety, and Depression. Analyses were conducted to examine clinical variables as a function of opioid use. The results indicated that opioid use was associated with female gender, unemployment, smoking, higher American Society of Anesthesiologists scores, greater number of previous surgeries, depression or anxiety, and worse expectation of surgery ( < 0.05). Multivariable analysis found opioid use to be a significant independent predictor of multiple PRO measures in patients undergoing knee surgery. Potential explanations for these findings are presented, and clinical implications are discussed.

The Influence of Preoperative Psychological States on Postoperative Outcomes Following Percutaneous Kyphoplasty(PKP)

“…PROMIS has proven to be effective in rapid evaluation of outcomes and reduce the burden of patients who complete the questionnaires due to its unique computer adaptive testing algorithm [12,28]. PROMIS have been increasingly adopted in orthopedic and spine conditions to capture patient-centered indicators of health status for use in clinical care, research, and cost-effectiveness analysis [5][6][7][8][9][10][11]. When compared to traditional surveys, PROMIS provides a more e cient and accurate way reporting patient symptoms, function, and healthrelated quality of life [5,6,12].…”

Evaluation of Preoperative Pain Using PROMIS Pain Interference in Knee Surgery Patients

“…Other studies in different surgical populations have found important preoperative predictors of postoperative pain to include female gender, severity of preoperative pain, younger age, preoperative anxiety, and preoperative opioid use. 17,[50][51][52][53] The PI score was significantly associated with two procedures: (1) anterior cruciate ligament reconstruction and (2) total knee arthroplasty. Anterior cruciate ligament reconstruction is typically performed after most of the pain from the injury has subsided; consequently, it is not an unusual finding that these patients had a better preoperative PI score.…”

Response to letter to the editor concerning “Orthopaedic surgery patients who use recreational marijuana have less pre-operative pain”

“…Lastly, we analysed both pre-operative opioid use and marijuana use as binary categorical variables: BYES-opioid-use^or BNO-opioid-use^, and BYES-non prescriptions drug use -marijuana^or BNO-prescription drug use -marijuana^. We have found that pre-operative opioid use is an important factor in this patient population [3], and we controlled for this in our multivariable analysis. Accurate quantification of preoperative opioid use is very difficult in orthopaedic patients as many prescriptions are provided prior to evaluation by the orthopaedic surgeon.…”