Preoperative Opioid Use Is Associated With Persistent Use, Readmission and Postoperative Complications After Arthroscopic Knee Surgery

Ridenour, Ryan; Kowalski, Christopher; Yadavalli, Aditya; Ba, Djibril M.; Liu, Guodong; Leslie, Douglas L.; Bible, Jesse E.; Aynardi, Michael; Garner, Matthew R.; Dhawan, Aman

doi:10.1016/j.arthro.2020.12.187

Cited by 15 publications

(12 citation statements)

References 17 publications

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“…Higher preoperative opioid usage was also associated with an increased risk of any complication and UTI. This association with preoperative opioid usage and postoperative complications has been demonstrated in several studies of different orthopaedic procedures including lumbar spine surgery ( 32 - 34 ). This increase in complications and UTI noted in this study and prior studies is possibly due to the immunomodulatory effect of opioids ( 35 ).…”

Section: Discussionmentioning

confidence: 65%

Lumbar spine surgery reduces postoperative opioid use in the veteran population

et al. 2022

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Background The United States has been facing a worsening opioid epidemic over the past two decades. The veteran population represents a large and vulnerable group with a higher burden of mental health comorbidities. The purpose of this study was to analyze the impact of lumbar spine surgery on postoperative opioid usage in the United States veteran population. Methods A retrospective cohort study was conducted using the Veterans Affairs Informatics and Computing Infrastructure database. Patients who underwent lumbar spine surgery were stratified into three groups by their preoperative opioid claims within 365 days of surgery. Postoperative cumulative morphine milligram equivalents (MME) were tracked for each group and the paired Wilcoxon signed rank test was used to compare cumulative preoperative MME (days −365–0) to cumulative postoperative MME (days 91–455). Results At one year, 30.6% of patients in the high preoperative opioid group and 73.1% of patients in the low preoperative opioid group were no longer using opioids. In the opioid naive cohort, 10.0% of patients were still using opioids at one year. Among all patients, median cumulative postoperative MME was significantly less than median cumulative preoperative MME (P<0.001). High preoperative opioid usage of more than 3 claims was most significantly associated with continued postoperative opioid usage (odds ratio 12.55, P<0.001). From 2010 to 2020 the proportion of patients with preoperative opioid claims decreased (58.8% to 34.8%). Conclusions In the veteran population, lumbar spine surgery was effective in getting 50% of patients who were on opioids preoperatively to discontinue opioids postoperatively. Even minimal exposure to opioids preoperatively resulted in a 2.69-time increase in risk of being on opioids at one year versus opioid naive patients. This study affirms that despite being a high-risk population, the veteran population has a similar response to lumbar spine surgery as the general population in regards to opioid dependence.

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Section: Discussionmentioning

confidence: 65%

Lumbar spine surgery reduces postoperative opioid use in the veteran population

et al. 2022

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“…Across multiple subspecialties in orthopaedic surgery, the literature has consistently demonstrated that preoperative opioid use strongly predicts prolonged opioid demand after surgery. 7 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 25 , 26 Anthony et al. 19 conducted a multicenter review of 4,946 ACL reconstructions and found that patients with preoperative prescriptions were 4.06 times (95% CI, relative risk 3.33-4.96) more likely to be refilling prescriptions at 2 months and 5.35 to 7.67 times more likely at all time points between 3 and 12 months after surgery.…”

Section: Discussionmentioning

confidence: 99%

“… 9 Multiple studies have investigated risk factors leading to prolonged opioid use after common orthopaedic surgeries (e.g., arthritis, psych history, etc.). 7 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 Identifying predictive factors for prolonged opioid use is crucial for orthopaedic surgeons to tailor pain control for specific patients and practice opioid stewardship.…”

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confidence: 99%

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

Castle

Jildeh

Buckley

et al. 2021

Arthroscopy, Sports Medicine, and Rehabilitation

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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.

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“…Therefore, we included utilisation of services in physical therapy, acupuncture and medication (non-opioids) for pain management 1 year before the KR intervention. Because a large strand of literature demonstrated the correlation between preoperative and postoperative opioids,9 37–46 we also included the presence of preoperative (12 months preceding KR) opioid prescriptions as an explanatory variable.…”

Section: Methodsmentioning

confidence: 99%

Opioid prescriptions after knee replacement: a retrospective study of pathways and prognostic factors in the Swiss healthcare setting

et al. 2023

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ObjectivesThe optimal use of opioids after knee replacement (KR) remains to be determined, given the growing evidence that opioids are no more effective than other analgesics and that their adverse effects can impair quality of life. Therefore, the objective is to examine opioid prescriptions after KR.DesignIn this retrospective study, we used descriptive statistics and estimated the association of prognostic factors using generalised negative binomial models.SettingThe study is based on anonymised claims data of patients with mandatory health insurance at Helsana, a leading Swiss health insurance.ParticipantsOverall, 9122 patients undergoing KR between 2015 and 2018 were identified.Primary and secondary outcome measuresBased on reimbursed bills, we calculated the dosage (morphine equivalent dose, MED) and the episode length (acute: <90 days; subacute: ≥90 to <120 days or <10 claims; chronic: ≥90 days and ≥10 claims or ≥120 days). The incidence rate ratios (IRRs) for postoperative opioids were calculated.ResultsOf all patients, 3445 (37.8%) received opioids in the postoperative year. A large majority had acute episodes (3067, 89.0%), 2211 (65.0%) had peak MED levels above 100 mg/day and most patients received opioids in the first 10 postoperative weeks (2881, 31.6%). Increasing age (66–75 and >75 vs 18–65) was associated with decreased IRR (0.776 (95% CI 0.7 to 0.859); 0.723 (95% CI 0.649 to 0.805)), whereas preoperative non-opioid analgesics and opioids were associated with higher IRR (1.271 (95% CI 1.155 to 1.399); 3.977 (95% CI 4.409 to 3.591)).ConclusionThe high opioid demand is unexpected given that current recommendations advise using opioids only when other pain therapies are ineffective. To ensure medication safety, it is important to consider alternative treatment options and ensure that benefits outweigh potential risks.

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Preoperative Opioid Use Is Associated With Persistent Use, Readmission and Postoperative Complications After Arthroscopic Knee Surgery

Cited by 15 publications

References 17 publications

Lumbar spine surgery reduces postoperative opioid use in the veteran population

Lumbar spine surgery reduces postoperative opioid use in the veteran population

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

Opioid prescriptions after knee replacement: a retrospective study of pathways and prognostic factors in the Swiss healthcare setting

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