Persistent post-operative opioid use following hip arthroscopy is common and is associated with pre-operative opioid use and age

Abstract

PurposeHip arthroscopy utilization continues to increase worldwide. Post‐operative pain management is essential to allow appropriate rehabilitation. While multimodal analgesic protocols have been described, consensus agreement is lacking and opioid analgesia remains a mainstay of treatment. Unfortunately, the risk of persistent opioid use among opioid‐naïve and non‐naïve patients following hip arthroscopy remains unclear. Therefore, the purpose of this study was to identify rates of persistent post‐operative opioid use, as well as to identify factors associated with persistent use. MethodsA retrospective cohort study was conducted using linked administrative data from Ontario, Canada. Participants were adults who underwent hip arthroscopy between 2013 and 2018. Patients < 18 or > 60 years of age as well as those who had undergone prior hip arthroscopy were excluded. The primary exposure was whether patients had filled ≥ 2 opioid prescriptions within 1 year prior to their hip arthroscopy to define the opioid naïve and non‐naïve populations. The primary outcome was persistent opioid use, defined as 2 + prescriptions filled between 9 and 15 months post‐op. A regression analysis was performed to identify factors associated with persistent opioid usage. ResultsOf the 1909 patients, 1525 (79.9%) were opioid‐naïve, while 384 (20.1%) had a prior history of opioid use within 1 year of surgery. 224 patients (11.7%) demonstrated persistent opioid use, with ≥ 2 prescriptions filled between 9 and 15 months post‐op. Of those, 42 (18.8%) cases were among opioid‐naïve patients, while the remaining 182 (81.2%) were among non‐naïve patients. The risk of persistent post‐operative use was significantly higher in those with prior opioid use (OR 31.95, 95% CI 22.15–46.09; p < 0.0001). Regression analysis confirmed that pre‐operative opioid use (OR 23.79, 95% CI 17.06–33.17; p < 0.0001) and older age (OR 1.04, 95% CI 1.02–1.05, p < 0.0001) were associated with increased risk of persistent post‐operative opioid use. ConclusionFollowing hip arthroscopy, persistent opioid use is common. New persistent use was identified in 2.7% of opioid‐naïve patients, compared with continued use in 47.4% of non‐naïve patients. Pre‐operative opioid use and older age were associated with the greater risk of persistent post‐operative opioid use. Level of evidenceLevel III.

Effect of Perioperative Opioid Use on Patients Undergoing Hip Arthroscopy

“…A far higher proportion of patients who used opioids preoperatively went on to request ≥2 more refills after their index arthroscopy, signifying that preoperative opioid use is a marker for potential prolonged opioid use after surgery, allowing for appropriate counseling and cessation efforts before surgery occurs. Our results reinforced what has been shown previously: preoperative opioid use before index hip arthroscopy remains one of the single most important predictors for chronic postoperative opioid use 2 , 11 , 14 , 21 , 50 and is closely tied to patient outcomes. 52 …”

“…A far higher proportion of patients who used opioids preoperatively went on to request 2 more refills after their index arthroscopy, signifying that preoperative opioid use is a marker for potential prolonged opioid use after surgery, allowing for appropriate counseling and cessation efforts before surgery occurs. Our results reinforced what has been shown previously: preoperative opioid use before index hip arthroscopy remains one of the single most important predictors for chronic postoperative opioid use 2,11,14,21,50 and is closely tied to patient outcomes. 52 In 2020, Beck et al 3 specifically assessed the connection between refills and postoperative outcome, determining that patients requiring more refills had lower patient-reported outcomes and visual analog scale (VAS) satisfaction score averages and higher VAS pain score averages after surgery.…”

“…In patients with preoperative opioid use, continued utilization of these mediations after hip arthroscopy has been documented to be as high as 47%. 14 When taken as a whole, mounting evidence incentivizes physicians to support opioid cessation before surgery to avoid prolonged postoperative use, complications associated with use, 4 , 34 opioid-induced hyperalgesia, 5 dependence, 51 and misuse. 5 , 49 Decreasing opioid use is particularly crucial as we navigate the ongoing opioid epidemic and define our role as surgical care providers in that setting.…”

Effects of Opioid-Limiting Legislation and Increased Provider Awareness on Postoperative Opioid Use and Complications After Hip Arthroscopy

“…Likewise, Cunningham et al 7 revealed that any opioid use 2 weeks before surgery was the strongest predictor of opioid use after hip arthroscopy. Finally, Degen et al 9 showed that the risk of persistent opioid use (ie, ≥2 prescriptions filled between 9 and 15 months postoperatively) was greatest in patients who used opioids within 1 year before hip arthroscopy. The relationship between preoperative and increased postoperative opioid consumption is generalizable beyond hip arthroscopy as well.…”

Genetic associations of persistent opioid use after surgery: a hypothesis-driven analysis of high-value genetic variants in the Michigan Genomics Initiative dataset

“…This disregard for less-severe outcomes creates di culty in establishing risk from medically directed opioid use. Moreover, while numerous studies in recent years examined the onset of persistent opioid use (POU) in postsurgical contexts, 31,33,[67][68][69][70][71][72][73][74][75][76][77][78][79][80][81][82][83][84][85] none evaluated the genetic architecture of POU, a gap our study lls. Our analysis of targeted candidate SNPs establishes a clear genetic connection between POU and OUD.…”