Purpose: To identify the current opioid prescribing and use practices after arthroscopic meniscectomy and to evaluate the role of preoperative patient education in decreasing postoperative opioid consumption. Methods: Patients undergoing arthroscopic meniscectomy were prospectively identified for inclusion. They were placed into 1 of 2 groups: Group 1 received no education regarding opioid use after surgery, whereas group 2 received a standardized overview on postoperative opioid use. Patients were assigned to the groups consecutively: Patients treated at the beginning of the study were assigned to group 1, and patients treated at the end of the study were assigned to group 2. Data from group 1 were used to identify "normal" opioid prescribing and use practices and to guide patients in group 2 regarding normal postoperative opioid use. Patients were surveyed weekly for 4 weeks after surgery to determine the number of opioids taken. Postoperative opioid consumption was analyzed and compared between the 2 groups. Results: A total of 62 patients completed the study (32 in group 1 and 30 in group 2). Patients in group 1 were prescribed an average of 42.0 opioid pills (95% confidence interval [CI], 34.0-51.0 pills) and used an average of 15.84 pills (95% CI, 9.26-22.4 pills) after surgery, whereas patients in group 2 used an average of 4.00 pills (95% CI, 2.12-5.88 pills) after surgery. Patients in group 2 used 11.84 fewer opioid pills (P ¼ .001), a 296% decrease in postoperative opioid consumption. The number of patients who continued to take opioid pills 4 weeks after surgery was 7 patients (21.9%) in group 1 and 1 patient (3.3%) in group 2. Conclusions: Preoperative patient education regarding opioids may decrease postoperative opioid consumption and the duration for which patients take opioid pills after arthroscopic meniscectomy. Level of Evidence: Level II, prospective comparative study.
Level III, prognostic study.
Background: Extensor mechanism injuries involving the quadriceps tendon, patella, or patellar tendon can be a devastating setback for athletes. Despite the potential severity and relative frequency with which these injuries occur, large-scale epidemiological data on collegiate-level athletes are lacking. Study Design: Descriptive epidemiology study. Level of Evidence: Level 4. Methods: Knee extensor mechanism injuries across 16 sports among National Collegiate Athletic Association (NCAA) men and women during the 2004-2005 to 2013-2014 academic years were analyzed using the NCAA Injury Surveillance Program (NCAA-ISP). Extensor mechanism injuries per 100,000 athlete-exposures (AEs), operative rate, annual injury and reinjury rates, in-season status (pre-/regular/postseason), and time lost were compiled and calculated. Results: A total of 11,778,265 AEs were identified and included in the study. Overall, 1,748 extensor mechanism injuries were identified, with an injury rate (IR) of 14.84 (per 100,000 AEs). N = 114 (6.5%) injuries were classified as severe injuries with a relatively higher median time loss (44 days) and operative risk (18.42%). Male athletes had higher risk of season-ending injuries in both all (3.20% vs 0.89%, P < 0.01) and severe (41.54% vs 16.33%, P < 0.01) extensor mechanism injuries. Similarly, contact injuries were more frequently season-ending injuries (4.44% vs 1.69%, P = 0.01). Women’s soccer (IR = 2.59), women’s field hockey (IR = 2.15), and women’s cross country (IR = 2.14) were the sports with the highest rate of severe extensor mechanism injuries. Conclusion: Extensor mechanism injuries in collegiate athletes represent a significant set of injuries both in terms of volume and potentially to their athletic careers. Male athletes and contact injuries appear to have a greater risk of severe injuries. Injuries defined as severe had a higher risk of operative intervention and greater amount of missed playing time. Clinical Relevance: Knowledge of the epidemiology of extensor mechanism injuries may help clinicians guide their athlete patients in sports-related injury prevention and management.
Objectives: Arthroscopic meniscectomy is one of the most common procedures in orthopedic surgery and is thus a frequent reason for prescription of post-operative opioid narcotics. Recent emphasis has been placed on limiting the number of opioid pills given for post-operative analgesia, with the goal being to provide adequate post-operative pain control while minimizing the number of unused pills after surgery. A number of modifiable variables have been identified to prevent over-prescription of opioids including prescriber education and identification of patient-specific factors associated with increased opioid use. To date, no study has evaluated the role of patient education to decrease post-operative opioid use. The goal of this study is to determine the utility of pre-operative patient education in decreasing post-operative opioid consumption after arthroscopic meniscectomy. Methods: All patients 18 years and older from a group of five attending surgeons undergoing isolated arthroscopic unicompartmental meniscectomy were prospectively identified for inclusion in this cohort study. Patients were split into two groups: patients in Group 1 did not receive any specific education regarding opioid usage after surgery while patients in Group 2 received a formalized three-minute overview from a physician on both appropriate usage of opioid narcotics as well as options for non-narcotic post-operative analgesia. Patients were assigned to each group consecutively - all patients at the beginning of the study were assigned to Group 1 while all patients at the end of the study were assigned to Group 2. Post-operatively, patients in both groups were surveyed via phone call one, two, three, and four weeks after surgery to determine the number of opioid pills taken each week. Patient descriptive statistics and post-operative opioid consumption were analyzed and compared between the two groups. Results: 62 patients completed the study, with 32 in Group 1 (no pre-operative education) and 24 in Group 2 (received pre-operative education). There were no significant demographic differences between the two groups. Patients in Group 1 used an average of 16.71 (95% CI, 9.67-23.75) opioid pills after surgery while patients in Group 2 used an average 3.21 (95% CI, 1.78-6.06) opioids after surgery. Patients in Group 2 used 13.5 less opioid pills (p = 0.001) representing a 420.0% decrease in post-operative opioid consumption over a four-week course (Figure 1). 7 (21.9%) patients in Group 1 continued to take opioid pills four weeks after surgery, while only 1 (4.2%) patient in Group 2 did the same. Conclusion: Pre-operative patient education regarding appropriate usage of opioid and options for non-narcotic analgesia significantly decreases post-operative opioid consumption and the duration which patients take opioid pills after arthroscopic meniscectomy. Pre-operative education is quick and inexpensive method to decrease post-operative opioid prescription requirements. [Figure: see text]
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