The impact of preoperative opioid use on outcomes after arthroscopic rotator cuff repair

Sabesan, Vani J.; Petersen-Fitts, Graysen; Sweet, Matthew C.; Katz, Danielle L.; Lima, Diego J.L.; Whaley, James

doi:10.1016/j.jses.2018.05.001

Cited by 27 publications

(21 citation statements)

References 14 publications

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“…Although our findings did not show any significant difference in expectations after lumbar spine surgery in patients who took opioids compared with non-users, management of lumbar spine surgery expectations based on preoperative opioid usage should be considered in the surgeon-patient discussion before surgery [ 27 , 28 ]. Previous studies showed that pre-surgical use of opioids is a predictor of various adverse postoperative outcomes in spine surgery such as severe self-rated pain and overall health, and is associated with increased length of hospitalization, surgical complications, and delays in returning to work [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies showed that pre-surgical use of opioids is a predictor of various adverse postoperative outcomes in spine surgery such as severe self-rated pain and overall health, and is associated with increased length of hospitalization, surgical complications, and delays in returning to work [ 29 ]. Moreover, opioid use before surgery is associated with a considerably higher risk of long-term opioid use and less improvement of the postoperative outcome, and preoperative pain management planning should take these observations into account [ 27 , 30 ].…”

Section: Discussionmentioning

confidence: 99%

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Expectations of Lumbar Surgery Outcomes among Opioid Users Compared with Non-Users

et al. 2020

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<sec><title>Study Design</title>Matched cohort study.</sec><sec><title>Purpose</title>To compare and describe the effect of opioid usage on the expectations of lumbar surgery outcomes among patients taking opioids and patients not taking opioids.</sec><sec><title>Overview of Literature</title>Chronic opioid use is common among lumbar-spine surgery patients. The decision to undergo elective lumbar surgery is influenced by the expected surgery outcomes. However, the effects of opioids on patients’ expectations of lumbar surgery outcomes remain to be rigorously assessed.</sec><sec><title>Methods</title>A total of 77 opioid users grouped according to dose and duration (54 “higher users,” 30 “lower users”) were matched 2:1 to 154 non-opioid users based on age, sex, marital status, chiropractic care, disability, and diagnosis. All patients completed a validated 20-item Expectations Survey measuring expected improvement with regard to symptoms, function, psychological well-being, and anticipated future spine condition. “Greater expectations” was defined as a higher survey score (possible range, 0–100) based on the number of items expected and degree of improvement expected.</sec><sec><title>Results</title>The mean Expectations Survey scores for all opioid users and all non-users were similar (73 vs. 70, <italic>p</italic>=0.18). Scores were different, however, for lower users (79) compared with matched non-users (69, <italic>p</italic>=0.01) and compared with higher users (70, <italic>p</italic>=0.01). In multivariable analysis, “greater expectations” was independently associated with having had chiropractic care (<italic>p</italic>=0.03), being more disabled (<italic>p</italic>=0.002), and being a lower-dose opioid user (<italic>p</italic>=0.03). Compared with higher users, lower users were also more likely to expect not to need pain medications 2 years after surgery (47% vs. 83%, <italic>p</italic>=0.003).</sec><sec><title>Conclusions</title>Patient expectations of lumbar surgery are associated with diverse demographic and clinical variables. A lower dose and shorter duration of opioid use were associated with expecting more items and expecting more complete improvement compared with non-users. In addition, lower opioid users had greater overall expectations compared with higher users.</sec>

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Expectations of Lumbar Surgery Outcomes among Opioid Users Compared with Non-Users

et al. 2020

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“…Preoperative opioid use is associated with a higher likelihood of prolonged opioid usage and increased dose requirements after arthroscopic RCR. 5 , 24 , 30 Similarly, Sabesan et al 24 examined a cohort of 79 patients who underwent arthroscopic RCR and observed that the patients with no opioid use had significantly higher patient-reported postoperative outcomes than the patients with a history of preoperative opioid use. Patients with preoperative opioid use did not reach the same level of functionality postoperatively as patients who did not use opioids and reported higher postoperative pain scores.…”

Section: Discussionmentioning

confidence: 99%

“…Patients with preoperative opioid use did not reach the same level of functionality postoperatively as patients who did not use opioids and reported higher postoperative pain scores. 24 , 30 In a retrospective examination of 35,155 arthroscopic RCR procedures performed over a 7-year study period, Westermann et al 29 reported that patients who filled opioid prescriptions 1 to 3 months before surgery were more likely to be filling opioid prescriptions up to 9 months after surgery.…”

Section: Discussionmentioning

confidence: 99%

Health Care Utilization and Costs in the Year Prior to Arthroscopic Rotator Cuff Repair

Malik

Sridharan

Bishop

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: A majority of cost-control strategies in arthroscopic rotator cuff repair (RCR) have been concentrated on the perioperative and post–acute care periods, with the preoperative health care period being largely overlooked. Purpose: To report the distribution of costs associated with health care utilization within the year prior to arthroscopic RCR. Study Design: Economic and decision analysis; Level of evidence, 3. Methods: The 2007 through 2015 (third quarter) Humana Administrative Claims database was queried using Current Procedural Terminology code 29827 to identify patients undergoing arthroscopic RCR for only degenerative rotator cuff tears. The study cohort was divided into 2 distinct groups based on insurance plan: commercial or Medicare Advantage (MA). Total 1-year costs, per-patient average reimbursements (PPARs), and trends in utilization for the following preoperative health care resource categories were studied: office visits, radiographs, magnetic resonance imaging (MRI) scans, computed tomography (CT) scans, steroid injections, hyaluronic acid (HA) injections, physical therapy, and pain medications (opioids + nonopioids). Results: A total of 18,457 MA and 6530 commercial beneficiaries undergoing arthroscopic RCR over the study period were included. Total 1-year preoperative costs (in US$) amounted to $16,923,595 ($916/patient) and $8,397,291 ($1285/patient) for MA and commercial beneficiaries, respectively. The largest proportion of total 1-year costs for both MA and commercial beneficiaries was accounted for by MRI scans (36% and 56%, respectively). PPARs for each health care resource category were as follows: office visits (MA, $240; commercial, $249), radiographs (MA, $60; commercial, $93), MRI scans (MA, $385; commercial, $813), CT scans (MA, $223; commercial, $562), steroid injections (MA, $97; commercial, $137), HA injections (MA, $422; commercial, $602), physical therapy (MA, $473; commercial, $551), and pain medications (MA, $208; commercial, $136). High health care utilization within the past 3 months before surgery was noted for radiographs, physical therapy, opioids, steroid injections, and office visits, with up to 40% to 90% of 1-year PPARs being accounted for within this time period alone. Conclusion: Approximately $900 to $1300 per patient was spent in rotator cuff–related health care resource use in the year prior to undergoing arthroscopic RCR. As we begin to implement value in shoulder surgery, judicious use of nonoperative treatment modalities among patients who would not benefit from nonoperative care will be an effective way of reducing costs.

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“…The authors found that >30% of these opioid-naive patients received at least one preoperative opioid prescription, and >8% showed prolonged use, with risk factors being "greater opioid use in the early postoperative period, mental health conditions, substance dependence and abuse, and pre-existing pain disorders." Comparing arthroscopic rotator cuff repair outcome between patients with and without a history of opioid use before surgery, Sabesan et al 18 showed that both groups benefited from surgery but that the opioid-naive patients had significantly better outcome scores than the opioid-familiar group. Williams et al 19 similarly showed that opioid-familiar arthroscopic rotator cuff repair patients used almost twice the amount of postoperative opioids over almost three times the duration as did opioid-naive patients.…”

mentioning

confidence: 99%

Opioids After Arthroscopy: We're Only Halfway Through the Crisis

Rossi¹,

Brand²,

Lubowitz³

2019

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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The orthopaedic community and the general medical community have made progress in the quest to control opioid abuse, but perhaps we are only halfway there. Ample literature has defined the crisis, and governmental guidelines have attempted to curb overprescribing. The American Board of Orthopaedic Surgery now emphasizes the importance of continuing education on the issue, and the arthroscopic and related surgical literature shows the deleterious effect of preoperative narcotic consumption and the opportunity to achieve positive outcomes while limiting postoperative opioid prescriptions. A comprehensive solution requires identifying the problem, considering multimodal anesthesia, avoiding overprescribing, acknowledging that minimizing opioid use is not equivalent to undertreating pain, minimizing preoperative opioid use, managing patient expectations, and continuing to investigate the outcomes of pain management while limiting opioid prescriptions or forgoing opioids altogether. "Twenty-two and a half more miles. and we'll be halfway there." Dave Mahre (1927e2005)

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The impact of preoperative opioid use on outcomes after arthroscopic rotator cuff repair

Cited by 27 publications

References 14 publications

Expectations of Lumbar Surgery Outcomes among Opioid Users Compared with Non-Users

Expectations of Lumbar Surgery Outcomes among Opioid Users Compared with Non-Users

Health Care Utilization and Costs in the Year Prior to Arthroscopic Rotator Cuff Repair

Opioids After Arthroscopy: We're Only Halfway Through the Crisis

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