J Knee Surg 2022; 35(05): 511-520
DOI: 10.1055/s-0040-1716358
Original Article

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

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
,
Aymen Alqazzaz
1   Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
,
Tristan Weir
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
,
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

Abstract

The objectives of this study are to assess perioperative opioid use in patients undergoing knee surgery and to examine the relationship between preoperative opioid use and 2-year postoperative patient-reported outcomes (PROs). We hypothesized that preoperative opioid use and, more specifically, higher quantities of preoperative opioid use would be associated with worse PROs in knee surgery patients. We studied 192 patients undergoing knee surgery at a single urban institution. Patients completed multiple PRO measures preoperatively and 2-year postoperatively, including six patient-reported outcomes measurement information system (PROMIS) domains; the International Knee Documentation Committee (IKDC) questionnaire, numeric pain scale (NPS) scores for the operative knee and the rest of the body, Marx's knee activity rating scale, Tegner's activity scale, International Physical Activity Questionnaire, as well as measures of met expectations, overall improvement, and overall satisfaction. Total morphine equivalents (TMEs) were calculated from a regional prescription monitoring program. Eighty patients (41.7%) filled an opioid prescription preoperatively, and refill TMEs were significantly higher in this subpopulation. Opioid use was associated with unemployment, government insurance, smoking, depression, history of prior surgery, higher body mass index, greater comorbidities, and lower treatment expectations. Preoperative opioid use was associated with significantly worse 2-year scores on most PROs, including PROMIS physical function, pain interference, fatigue, social satisfaction, IKDC, NPS for the knee and rest of the body, and Marx's and Tegner's scales. There was a significant dose-dependent association between greater preoperative TMEs and worse scores for PROMIS physical function, pain interference, fatigue, social satisfaction, NPS body, and Marx's and Tegner's scales. Multivariable analysis confirmed that any preoperative opioid use, but not quantity of TMEs, was an independent predictor of worse 2-year scores for function, activity, and knee pain. Preoperative opioid use and TMEs were neither independent predictors of met expectations, satisfaction, patient-perceived improvement, nor improvement on any PROs. Our findings demonstrate that preoperative opioid use is associated with clinically relevant worse patient-reported knee function and pain after knee surgery.



Publication History

Received: 02 May 2020

Accepted: 21 July 2020

Article published online:
08 September 2020

© 2020. Thieme. All rights reserved.

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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
  • 2 Chou R, Fanciullo GJ, Fine PG. et al. American Pain Society-American Academy of Pain Medicine Opioids Guidelines Panel. Clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain. J Pain 2009; 10 (02) 113-130
  • 3 Frenk SM, Porter KS, Paulozzi LJ. Prescription opioid analgesic use among adults: United States, 1999-2012. NCHS Data Brief 2015; (189) 1-8
  • 4 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
  • 5 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
  • 6 Volkow ND, McLellan TA, Cotto JH, Karithanom M, Weiss SR. Characteristics of opioid prescriptions in 2009. JAMA 2011; 305 (13) 1299-1301
  • 7 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
  • 8 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
  • 9 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
  • 10 Meredith SJ, Nadarajah V, Jauregui JJ. et al. Preoperative opioid use in knee surgery patients. J Knee Surg 2019; 32 (07) 630-636
  • 11 Weick J, Bawa H, Dirschl DR, Luu HH. Preoperative opioid use is associated with higher readmission and revision rates in total knee and total hip arthroplasty. J Bone Joint Surg Am 2018; 100 (14) 1171-1176
  • 12 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
  • 13 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
  • 14 Manchikanti L, Helm II S, Fellows B. et al. Opioid epidemic in the United States. Pain Physician 2012; 15 (03) ES9-ES38
  • 15 Koehler RM, Okoroafor UC, Cannada LK. A systematic review of opioid use after extremity trauma in orthopedic surgery. Injury 2018; 49 (06) 1003-1007
  • 16 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
  • 17 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
  • 18 Cozowicz C, Olson A, Poeran J. et al. Opioid prescription levels and postoperative outcomes in orthopedic surgery. Pain 2017; 158 (12) 2422-2430
  • 19 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
  • 20 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
  • 21 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 (01) , Suppl A ): 62-67
  • 22 Westermann RW, Anthony CA, Bedard N. et al. Opioid consumption after rotator cuff repair. Arthroscopy 2017; 33 (08) 1467-1472
  • 23 Wojahn RD, Bogunovic L, Brophy RH. et al. Opioid consumption after knee arthroscopy. J Bone Joint Surg Am 2018; 100 (19) 1629-1636
  • 24 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
  • 25 Okoroha KR, Lu Y, Nwachukwu BU. et al. How should we define clinically significant improvement on patient-reported outcomes measurement information system test for patients undergoing knee meniscal surgery?. Arthroscopy 2020; 36 (01) 241-250
  • 26 Gowd AK, Lalehzarian SP, Liu JN. et al. Factors associated with clinically significant patient-reported outcomes after primary arthroscopic partial meniscectomy. Arthroscopy 2019; 35 (05) 1567-1575.e3
  • 27 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
  • 28 Vranceanu AM, Bachoura A, Weening A, Vrahas M, Smith RM, Ring D. Psychological factors predict disability and pain intensity after skeletal trauma. J Bone Joint Surg Am 2014; 96 (03) e20
  • 29 Helmerhorst GT, Vranceanu AM, Vrahas M, Smith M, Ring D. Risk factors for continued opioid use one to two months after surgery for musculoskeletal trauma. J Bone Joint Surg Am 2014; 96 (06) 495-499
  • 30 Sullivan MD. Depression effects on long-term prescription opioid use, abuse, and addiction. Clin J Pain 2018; 34 (09) 878-884
  • 31 Baldini A, Von Korff M, Lin EH. A review of potential adverse effects of long-term opioid therapy: a practitioner's guide. Prim Care Companion CNS Disord 2012; 14 (03) PCC.11m01326
  • 32 Younger JW, Chu LF, D'Arcy NT, Trott KE, Jastrzab LE, Mackey SC. Prescription opioid analgesics rapidly change the human brain. Pain 2011; 152 (08) 1803-1810
  • 33 Nadarajah V, Glazier E, Miller K. et al. Evaluation of preoperative pain using promis pain interference in knee surgery patients. J Knee Surg 2020; 33 (09) 875-883 ( e-pub ahead of print). Doi: 10.1055/s-0039-1688769
  • 34 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