Preoperative Opioid Use in Knee Surgery Patients

Sean J. Meredith; Vidushan Nadarajah; Julio J. Jauregui; Michael P. Smuda; Shaun H. Medina; Craig H. Bennett; Jonathan D. Packer; R. Frank Henn III

doi:10.1055/s-0038-1666868

The Journal of Knee Surgery, Table of Contents

J Knee Surg 2019; 32(07): 630-636
DOI: 10.1055/s-0038-1666868

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Preoperative Opioid Use in Knee Surgery Patients

Authors

Sean J. Meredith

¹Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
Vidushan Nadarajah

¹Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland

²Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Medical Center, Brooklyn, New York
Julio J. Jauregui

¹Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
Michael P. Smuda

¹Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
Shaun H. Medina

¹Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
Craig H. Bennett

¹Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
Jonathan D. Packer

¹Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
R. Frank Henn III

¹Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland

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 (p < 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.

Keywords

opioid - knee - surgery - clinical characteristics - substance use

Full Text

References

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
2 Dart RC, Severtson SG, Bucher-Bartelson B. Trends in opioid analgesic abuse and mortality in the United States. N Engl J Med 2015; 372 (16) 1573-1574
3 Volkow ND, McLellan TA, Cotto JH, Karithanom M, Weiss SR. Characteristics of opioid prescriptions in 2009. JAMA 2011; 305 (13) 1299-1301
4 Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain--United States, 2016. JAMA 2016; 315 (15) 1624-1645
5 Lee D, Armaghani S, Archer KR. , et al. Preoperative opioid use as a predictor of adverse postoperative self-reported outcomes in patients undergoing spine surgery. J Bone Joint Surg Am 2014; 96 (11) e89
6 Lawrence JT, London N, Bohlman HH, Chin KR. Preoperative narcotic use as a predictor of clinical outcome: results following anterior cervical arthrodesis. Spine 2008; 33 (19) 2074-2078
7 Morris BJ, Laughlin MS, Elkousy HA, Gartsman GM, Edwards TB. Preoperative opioid use and outcomes after reverse shoulder arthroplasty. J Shoulder Elbow Surg 2015; 24 (01) 11-16
8 Morris BJ, Sciascia AD, Jacobs CA, Edwards TB. Preoperative opioid use associated with worse outcomes after anatomic shoulder arthroplasty. J Shoulder Elbow Surg 2016; 25 (04) 619-623
9 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
10 Rozell JC, Courtney PM, Dattilo JR, Wu CH, Lee GC. Preoperative opiate use independently predicts narcotic consumption and complications after total joint arthroplasty. J Arthroplasty 2017; 32 (09) 2658-2662
11 Fidai MS, Saltzman BM, Meta F. , et al. Patient-reported outcomes measurement information system and legacy patient-reported outcome measures in the field of orthopaedics: a systematic review. Arthroscopy 2018; 34 (02) 605-614
12 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
13 Tashjian RZ, Bradley MP, Tocci S, Rey J, Henn RF, Green A. Factors influencing patient satisfaction after rotator cuff repair. J Shoulder Elbow Surg 2007; 16 (06) 752-758
14 Henn III RF, Kang L, Tashjian RZ, Green A. Patients' preoperative expectations predict the outcome of rotator cuff repair. J Bone Joint Surg Am 2007; 89 (09) 1913-1919
15 McLellan AT, Luborsky L, Woody GE, O'Brien CP. An improved diagnostic evaluation instrument for substance abuse patients. The Addiction Severity Index. J Nerv Ment Dis 1980; 168 (01) 26-33
16 First MB. Structured Clinical Interview for the DSM (SCID). In The Encyclopedia of Clinical Psychology. New York, NY: John Wiley & Sons, Inc.; 2014
17 Webster LR, Webster RM. Predicting aberrant behaviors in opioid-treated patients: preliminary validation of the Opioid Risk Tool. Pain Med 2005; 6 (06) 432-442
18 Brenton A, Lee C, Lewis K. , et al. A prospective, longitudinal study to evaluate the clinical utility of a predictive algorithm that detects risk of opioid use disorder. J Pain Res 2018; 11: 119-131
19 Seymour RB, Ring D, Higgins T, Hsu JR. Leading the way to solutions to the opioid epidemic: AOA critical issues. J Bone Joint Surg Am 2017; 99 (21) e113
20 American Academy of Orthopaedic Surgeons. Opioid use, misuse, and abuse in orthopaedic practice. 2011. Available at: https://www-aaos-org.ezproxy.med.nyu.edu/uploadedFiles/PreProduction/About/Opinion_Statements/advistmt/1045OpioidUse,Misuse,andAbuseinPractice.pdf
21 Nguyen LC, Sing DC, Bozic KJ. Preoperative reduction of opioid use before total joint arthroplasty. J Arthroplasty 2016; 31 (9, Suppl): 282-287
22 Smith SR, Bido J, Collins JE, Yang H, Katz JN, Losina E. Impact of preoperative opioid use on total knee arthroplasty outcomes. J Bone Joint Surg Am 2017; 99 (10) 803-808
23 Zywiel MG, Stroh DA, Lee SY, Bonutti PM, Mont MA. Chronic opioid use prior to total knee arthroplasty. J Bone Joint Surg Am 2011; 93 (21) 1988-1993
24 Sing DC, Barry JJ, Cheah JW, Vail TP, Hansen EN. Long-acting opioid use independently predicts perioperative complication in total joint arthroplasty. J Arthroplasty 2016; 31 (9, Suppl): 170-174
25 Ben-Ari A, Chansky H, Rozet I. Preoperative opioid use is associated with early revision after total knee arthroplasty: a study of male patients treated in the Veterans Affairs System. J Bone Joint Surg Am 2017; 99 (01) 1-9
26 Cancienne JM, Patel KJ, Browne JA, Werner BC. Narcotic use and total knee arthroplasty. J Arthroplasty 2018; 33 (01) 113-118