Opioid Prescribing Habits for Common Arthroscopic Procedures in Opioid Naïve Patients

Abstract

Background: With the opioid epidemic and the increasing number of opioid-related deaths, there is growing awareness in the medical community regarding the dangers of opioid overprescription. As a result, there is a willingness among physicians to abandon old norms and adopt new data-driven prescribing practices. Purpose: To demonstrate patient-reported consumption data of opioid medications after anterior cruciate ligament (ACL) reconstructions (ACLRs), knee arthroscopies, and rotator cuff repairs to provide data-driven guidelines for prescribing opioids after these procedures. Study Design: Case series; Level of evidence, 4. Methods: Included in the study were 168 patients who underwent an ACLR, knee arthroscopy, or arthroscopic rotator cuff repair over a 17-month period. Patients were excluded if they had an opioid allergy, had preexisting opioid use, had an acute postoperative complication requiring further surgery, required hospitalization, exhibited drug-seeking behaviors, or were lost to follow-up. Medical records were reviewed to determine the number of opioid pills prescribed and the number of pills taken postoperatively. Prescribing was standardized in that 15 hydrocodone/acetaminophen pills (5/325 mg) were prescribed for all knee arthroscopy procedures and 40 hydrocodone/acetaminophen pills were prescribed for all ACL and rotator cuff procedures. The mean number of pills consumed and percentage of prescribed pills taken were analyzed in association with specific procedures and patient demographics. Results: Overall, the mean (±SD) reported opioid consumption overall was 13.5 ± 13.0 pills, with a utilization rate of 45.6% of the prescription. The mean reported opioid consumption for ACLRs, knee arthroscopies, and rotator cuff repairs was 19.1 ± 15.4, 7.2 ± 5.4, and 17.2 ± 14.3 pills, respectively ( P < .001). This represented a utilization rate of 48%, 47%, and 41%, respectively. Conclusion: This study provides important information regarding opioid utilization after common arthroscopic procedures. For ACLRs, knee arthroscopies, and rotator cuff repairs, by respectively prescribing 20, 10, and 20 pills postoperatively, the amount of unused medications would decrease by 60%, 47%, and 64%, respectively. We recommend prescribing no more than 20, 10, and 20 hydrocodone/acetaminophen pills (5/325 mg) for ACLRs, knee arthroscopies, and arthroscopic rotator cuff repairs, respectively.

Factors Associated With Increased Opioid Prescriptions Following Anterior Cruciate Ligament Reconstruction in Opioid-Naïve Patients

“…In a recent study, Thompson et al. 14 reported an increasing opioid use with age, the lowest use being in the <17 years of age category. Sayegh et al.…”

“…Thompson et al. 14 reported that the mean number of pills taken following ACLR was 19 ± 15 in their cohort and suggested that prescribing 20 pills of 5-mg hydrocodone/325-mg acetaminophen would provide satisfactory pain management after ACLR. Similarly, Sayegh et al.…”

“…The mechanism of ACL injury, as well as the surgical technique (anatomic vs transtibial, all-inside vs inside-out) or grafts of ACLR performed (bone–patellar tendon–bone vs hamstring vs quadriceps tendon autografts vs allograft) cannot accurately be assessed, although the graft choice (allograft vs autograft) was reported not to affect the opioid use. 14 Further, although the database identified prescriptions written by providers from various specialties and filled by patients, the exact number of pills taken by patients could not be identified. However, it is known that patients are not prescribed opioids unless their previous prescription is completed.…”

Lower Opioid Prescription Quantity Does Not Negatively Impact Pain Control or Patient Satisfaction After ACL Reconstruction

“…contrast with our initial hypothesis that male patients and those of a younger age group would take more opioids and report lower satisfaction scores compared with female patients and an older demographic group. The assertion that opioids are prescribed in excess following ACLR and other arthroscopic procedures is not novel, as some reports have suggested that 25% to 88% of patients are prescribed more pills than are required postoperatively [15][16][17] . In the present study, >40% of all opioids prescribed for patients after ACLR went unused, again supporting previous literature and underscoring an opportunity for the orthopaedic surgeon to refine opioid prescription practices to achieve the acceptable minimum or even avoid opioids altogether.…”