Preoperative Opioid Use Is a Risk Factor for Revision Surgery, Complications, and Increased Resource Utilization After Arthroscopic Rotator Cuff Repair

Abstract

Background: Studies have shown preoperative opioid use to influence outcomes after various surgical procedures. Researchers have not assessed this relationship after rotator cuff repair (RCR). Hypothesis/Purpose: The purpose of this study was to assess the relationship between preoperative opioid use and outcomes after arthroscopic RCR. We hypothesized that patients prescribed higher daily averages of preoperative oral morphine equivalents (OMEs) would show increased rates of 90-day complications and 3-year revision surgery. Study Design: Cohort study; Level of evidence, 3. Methods: The MarketScan claims database was utilized to identify patients who underwent arthroscopic RCR between 2009 and 2018. We used preoperative opioid use status to divide patients into groups based on the average daily OMEs consumed in the 6 months before surgery: opioid-naïve, <1, 1-<5, 5-<10, and ≥10 OMEs per day. We retrieved 90-day complication and 3-year revision surgery rates. Opioid use groups were then compared with binomial logistic regression and generalized linear models. Results: We identified 214,283 patients. Of those patients, 50.7% did not receive any preoperative opioids, while 7.7%, 26.8%, 6.3%, and 8.6% received <1, 1-<5, 5-<10, and ≥10 OMEs per day over a 6-month time period, respectively. Complications increased with increasing preoperative OMEs. Multivariate analysis revealed that any patient using ≥1 OME per day had increased rates of 3-year revision surgery, reoperations, and infections. Specifically, patients averaging ≥10 OMEs per day showed a 103% (odds ratio, 2.03 [95% CI, 1.62-2.54]; P < .001) increase in the odds of revision surgery compared with opioid-naïve patients. Rates of hospital admissions and postoperative emergency department encounters were higher in all opioid use groups. Adjusted differences in 6-month preoperative and 3-month postoperative health care costs were seen in the opioid use groups compared with opioid-naïve patients, ranging from US$1307 to US$5820 ( P < .001). Conclusion: Preoperative opioid use was a risk factor for complications and revision surgery after arthroscopic RCR. We also observed a dose-dependent response between opioid use and postoperative complications.

Association of Preoperative Opioid Use With Complication Rates and Resource Use in Patients Undergoing Hip Arthroscopy for Femoroacetabular Impingement

“…Our results suggested that preoperative opioid use may be associated with worsened perioperative pain and may lead to subsequent need for medical care. This relationship has been observed in open procedures such as hip and knee arthroplasty, as well as arthroscopic rotator cuff repair, where preoperative opioid use was associated with increases in postoperative complication rates, 4,6,17,26,38,45 postoperative narcotic consumption, 45 readmission, 6,26,58 revision, 5,17,26,52,58 costs, 6,17 and patient dissatisfaction. 19,51 The reasons for our findings are likely multifaceted and probably involve both physiologic and psychosocial factors.…”

“…These cutoffs were selected in order to capture a diverse set of preoperative opioid dosing strategies, and they are similar to those previously reported in the literature. 17…”

Satisfactory Pain Management With Minimal Opioid Use After Arthroscopic Rotator Cuff Repair

“… 22 Recently, Farley et al. 23 showed that preoperative opioid use and increased dosage was a risk factor for postoperative complications and revision surgery. In our cohort, only 8.5% of patients used opioids preoperatively, and this had no association with postoperative pain management satisfaction.…”

Evidenced-Based Opioid Prescribing Recommendations Following Hand and Upper-Extremity Surgery

“… 18 Beyond the greater societal consequences, excessive opioid use directly affects the hand surgeon’s daily practice. Farley et al 19 , 20 showed that preoperative opioid use was associated with poorer surgical outcomes and greater complication and revision rates in thumb carpometacarpal (CMC) arthroplasty and arthroscopic rotator cuff repair. Opioid misuse has been associated with increased overall morbidity (odds ratio, 2.3) and mortality (odds ratio, 3.7) after elective hand surgery.…”