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J Knee Surg 2022; 35(10): 1106-1118
DOI: 10.1055/s-0040-1722326
Original Article

Impact of Postoperative Opioid Use on 2-Year Patient-Reported Outcomes in Knee Surgery Patients

Xuyang Song
1   Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
,
Patrick M.J. Sajak
1   Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
,
Ali Aneizi 
1   Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
,
Aymen Alqazzaz
1   Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
,
Cameran I. Burt
1   Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
,
Dominic J. Ventimiglia
1   Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
,
Sean J. Meredith
1   Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
,
Natalie L. Leong
1   Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
,
Jonathan D. Packer
1   Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
,
R. Frank Henn III
1   Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
› Author Affiliations Funding This work was supported by a grant from the James Lawrence Kernan Hospital Endowment Fund, Inc.
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Abstract

The purposes of this study were to identify the patient characteristics associated with refilling a postoperative opioid prescription after knee surgery and to determine whether refilling opioids is associated with 2-year patient-reported outcomes. We hypothesized that postoperative refill of opioids would be associated with worse 2-year patient-reported outcomes. We studied 192 patients undergoing knee surgery at a single urban academic institution. Patients completed multiple patient-reported outcome measures preoperatively and 2 years postoperatively, including six Patient-Reported Outcomes Measurement Information System (PROMIS) domains, the International Knee Documentation Committee (IKDC) questionnaire, numeric pain scale scores for the operative knee and the rest of the body, Marx Activity Rating Scale, as well as measures of met expectations, improvement, and satisfaction. Total morphine equivalents (TMEs) were calculated from a regional prescription monitoring program. Patients who refilled a postoperative opioid prescription were compared with those who did not, and TMEs were calculated for those who refilled (Refill TMEs). One hundred twenty-nine patients (67%) refilled at least one postoperative opioid prescription. Black race, older age, higher average body mass index (BMI), smoking, greater medical comorbidities, preoperative opioid use, lower income, government insurance, and knee arthroplasty were associated with refilling opioids. Greater Refill TMEs was associated with black or white race, older age, higher average BMI, smoking, greater medical comorbidities, preoperative opioid use, government insurance, and unemployment. Refilling opioids and greater Refill TMEs were associated with worse postoperative scores on most patient-reported outcome measures 2 years after knee surgery. However, refilling opioids and greater Refill TMEs did not have a significant association with improvement after surgery. Multivariable analysis controlling for potential confounding variables confirmed that greater postoperative Refill TMEs independently predicted worse 2-year PROMIS Physical Function, 2-year PROMIS Pain Interference, and 2-year IKDC knee function scores. Postoperative refill of opioids was associated with worse 2-year patient-reported outcomes in a dose-dependent fashion. These findings reinforce the importance of counseling patients regarding opioid use and optimizing opioid-sparing pain management postoperatively.

Keywords

knee surgery - opioids - patient-reported outcomes - total morphine equivalent


Publication History

Received: 25 June 2020

Accepted: 12 November 2020

Article published online:
22 February 2021

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  • References

  • 1 Kumar K, Gulotta LV, Dines JS. et al. Unused opioid pills after outpatient shoulder surgeries given current perioperative prescribing habits. Am J Sports Med 2017; 45 (03) 636-641
    Google Scholar
  • 2 Frenk SM, Porter KS, Paulozzi LJ. Prescription opioid analgesic use among adults: United States, 1999-2012. NCHS Data Brief 2015; (189) 1-8
    PubMedGoogle Scholar
  • 3 Dart RC, Surratt HL, Cicero TJ. et al. Trends in opioid analgesic abuse and mortality in the United States. N Engl J Med 2015; 372 (03) 241-248
    Google Scholar
  • 4 Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain - United States, 2016. MMWR Recomm Rep 2016; 65 (01) 1-49
    Google Scholar
  • 5 Volkow ND, McLellan TA, Cotto JH, Karithanom M, Weiss SR. Characteristics of opioid prescriptions in 2009. JAMA 2011; 305 (13) 1299-1301
    CrossrefPubMedGoogle Scholar
  • 6 Koehler RM, Okoroafor UC, Cannada LK. A systematic review of opioid use after extremity trauma in orthopedic surgery. Injury 2018; 49 (06) 1003-1007
    CrossrefPubMedGoogle Scholar
  • 7 Overton HN, Hanna MN, Bruhn WE, Hutfless S, Bicket MC, Makary MA. Opioids After Surgery Workgroup. Opioid-prescribing guidelines for common surgical procedures: an expert panel consensus. J Am Coll Surg 2018; 227 (04) 411-418
    CrossrefPubMedGoogle Scholar
  • 8 Menendez ME, Ring D, Bateman BT. Preoperative opioid misuse is associated with increased morbidity and mortality after elective orthopaedic surgery. Clin Orthop Relat Res 2015; 473 (07) 2402-2412
    CrossrefPubMedGoogle Scholar
  • 9 Rozell JC, Courtney PM, Dattilo JR, Wu CH, Lee G-C. Preoperative opiate use independently predicts narcotic consumption and complications after total joint arthroplasty. J Arthroplasty 2017; 32 (09) 2658-2662
    CrossrefPubMedGoogle Scholar
  • 10 Cozowicz C, Olson A, Poeran J. et al. Opioid prescription levels and postoperative outcomes in orthopedic surgery. Pain 2017; 158 (12) 2422-2430
    CrossrefPubMedGoogle Scholar
  • 11 Bedard NA, Pugely AJ, Westermann RW, Duchman KR, Glass NA, Callaghan JJ. Opioid use after total knee arthroplasty: trends and risk factors for prolonged use. J Arthroplasty 2017; 32 (08) 2390-2394
    CrossrefPubMedGoogle Scholar
  • 12 Bedard NA, DeMik DE, Dowdle SB, Callaghan JJ. Trends and risk factors for prolonged opioid use after unicompartmental knee arthroplasty. Bone Joint J 2018; 100-B (1, supple A): 62-67
    CrossrefPubMedGoogle Scholar
  • 13 Anthony CA, Westermann RW, Bedard N. et al. Opioid demand before and after anterior cruciate ligament reconstruction. Am J Sports Med 2017; 45 (13) 3098-3103
    CrossrefPubMedGoogle Scholar
  • 14 Westermann RW, Anthony CA, Bedard N. et al. Opioid consumption after rotator cuff repair. Arthroscopy 2017; 33 (08) 1467-1472
    CrossrefPubMedGoogle Scholar
  • 15 Bedard NA, Pugely AJ, Dowdle SB, Duchman KR, Glass NA, Callaghan JJ. Opioid use following total hip arthroplasty: trends and risk factors for prolonged use. J Arthroplasty 2017; 32 (12) 3675-3679
    Google Scholar
  • 16 Wojahn RD, Bogunovic L, Brophy RH. et al. Opioid consumption after knee arthroscopy. J Bone Joint Surg Am 2018; 100 (19) 1629-1636
    CrossrefPubMedGoogle Scholar
  • 17 Rao AG, Chan PH, Prentice HA. et al. Risk factors for postoperative opioid use after elective shoulder arthroplasty. J Shoulder Elbow Surg 2018; 27 (11) 1960-1968
    CrossrefPubMedGoogle Scholar
  • 18 Kim KY, Anoushiravani AA, Chen KK, Roof M, Long WJ, Schwarzkopf R. Preoperative chronic opioid users in total knee arthroplasty-which patients persistently abuse opiates following surgery?. J Arthroplasty 2018; 33 (01) 107-112
    Google Scholar
  • 19 Nota SPFT, Spit SA, Voskuyl T, Bot AGJ, Hageman MGJS, Ring D. Opioid use, satisfaction, and pain intensity after orthopedic surgery. Psychosomatics 2015; 56 (05) 479-485
    CrossrefPubMedGoogle Scholar
  • 20 Bot AGJ, Bekkers S, Arnstein PM, Smith RM, Ring D. Opioid use after fracture surgery correlates with pain intensity and satisfaction with pain relief. Clin Orthop Relat Res 2014; 472 (08) 2542-2549
    CrossrefPubMedGoogle Scholar
  • 21 Helmerhorst GTT, Lindenhovius ALC, Vrahas M, Ring D, Kloen P. Satisfaction with pain relief after operative treatment of an ankle fracture. Injury 2012; 43 (11) 1958-1961
    CrossrefPubMedGoogle Scholar
  • 22 Henn III RF, Dubina AG, Jauregui JJ, Smuda MP, Tracy JK. The Maryland Orthopaedic Registry (MOR): design and baseline characteristics of a prospective registry. J Clin Orthop Trauma 2017; 8 (04) 301-307
    CrossrefPubMedGoogle Scholar
  • 23 Bergstrom N, Braden BJ, Laguzza A, Holman V. The Braden scale for predicting pressure sore risk. Nurs Res 1987; 36 (04) 205-210
    CrossrefPubMedGoogle Scholar
  • 24 Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research Electronic Data Capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42 (02) 377-381
    Google Scholar
  • 25 Somerson JS, Bhandari M, Vaughan CT, Smith CS, Zelle BA. Lack of diversity in orthopaedic trials conducted in the United States. J Bone Joint Surg Am 2014; 96 (07) e56
    Google Scholar
  • 26 Kim JH, Park EC. Impact of socioeconomic status and subjective social class on overall and health-related quality of life. BMC Public Health 2015; 15: 783
    Google Scholar
  • 27 Barrack RL, Ruh EL, Chen J. et al. Impact of socioeconomic factors on outcome of total knee arthroplasty. Clin Orthop Relat Res 2014; 472 (01) 86-97
    CrossrefPubMedGoogle Scholar
  • 28 Waldrop II LD, King III JJ, Mayfield J. et al. The effect of lower socioeconomic status insurance on outcomes after primary shoulder arthroplasty. J Shoulder Elbow Surg 2018; 27 (6S): S35-S42
    CrossrefPubMedGoogle Scholar
  • 29 Hernandez NM, Parry JA, Mabry TM, Taunton MJ. Patients at risk: preoperative opioid use affects opioid prescribing, refills and outcomes after total knee arthroplasty. J Arthroplasty 2018; 33 (7S): S142-S146
    Google Scholar
  • 30 Hooten WM, Shi Y, Gazelka HM, Warner DO. The effects of depression and smoking on pain severity and opioid use in patients with chronic pain. Pain 2011; 152 (01) 223-229
    CrossrefPubMedGoogle Scholar
  • 31 Apovian CM. Obesity: definition, comorbidities, causes, and burden. Am J Manag Care 2016; 22 (7, Suppl): s176-s185
    PubMedGoogle Scholar
  • 32 Zhang TT, Liu Z, Liu YL, Zhao JJ, Liu DW, Tian QB. Obesity as a risk factor for low back pain: a meta-analysis. Clin Spine Surg 2018; 31 (01) 22-27
    CrossrefPubMedGoogle Scholar
  • 33 Shiri R, Falah-Hassani K, Heliövaara M. et al. Risk factors for low back pain: a population-based longitudinal study. Arthritis Care Res (Hoboken) 2019; 71 (02) 290-299
    CrossrefPubMedGoogle Scholar
  • 34 Jasinski-Bergner S, Radetzki AL, Jahn J, Wohlrab D, Kielstein H. Impact of the body mass index on perioperative immunological disturbances in patients with hip and knee arthroplasty. J Orthop Surg Res 2017; 12 (01) 58
    CrossrefPubMedGoogle Scholar
  • 35 Bliddal H, Leeds AR, Christensen R. Osteoarthritis, obesity and weight loss: evidence, hypotheses and horizons - a scoping review. Obes Rev 2014; 15 (07) 578-586
    CrossrefPubMedGoogle Scholar
  • 36 Novak EJ, Vail TP, Bozic KJ. Advances in orthopaedic outcomes research. J Surg Orthop Adv 2008; 17 (03) 200-203
    Google Scholar
  • 37 Meredith SJ, Nadarajah V, Jauregui JJ. et al. Preoperative opioid use in knee surgery patients. J Knee Surg 2019; 32 (07) 630-636
    Article in Thieme ConnectPubMedGoogle Scholar