Opioid use before ACL surgery likely linked with longer postoperative use
Using information collected from a health insurance database, investigators found 35% of patients, who underwent ACL reconstruction had filled an opioid medication prescription in the 3 months leading up to surgery and that these patients were at greater risk for filling opioid prescriptions postoperatively.
According to study investigator Christopher A. Anthony, MD, the findings suggest preoperative opioid use is a significant risk factor for postoperative opioid use.
“There was over a five-times increased risk to be filling an opioid prescription postoperatively at 3 months if they had filled a prescription at any time point prior to surgery — 7.5-times increased risk at 9 months, six-times increased risk at 1 year,” Anthony said at his presentation at the American Orthopaedic Society for Sports Medicine Annual Meeting.
To define opioid utilization before and after ACL reconstruction, analyze the impact of preoperative opioid prescriptions on postoperative opioid demand and to evaluate the effect of additional procedures and patient age on postoperative opioid use, investigators used the Humana Inc. database to identify approximately 5,000 ACL reconstructions performed during a 7-year period.
According to the analysis, Anthony and his colleagues found 7%of patients were still filling opioid prescriptions 3 months postoperatively, with almost 5% still filling prescriptions after 12 months. Patients younger than 25 years old were found to be four-times as likely to be filling opioid prescriptions at 9 months postoperatively compared with other patients, and patients who underwent ACL reconstruction with microfracture were at increased risk of filling prescriptions postoperatively at nearly all time points.
Touching on the opioid epidemic in the United States, Anthony said, “[It’s] not only the opioids we prescribe to our patients that are an issue, it’s also the opioids left over,” which can lead to long-term use and abuse.
“We recommend that prescribers seek alternative pain control regimens in the setting of ACL reconstruction, and then health care systems and policy makers be aware that preoperative opioid use is prevalent and is a significant risk factor for postoperative use, and that age and microfracture are increased risk factors for postoperative opioid use,” Anthony said. – by Rhiannon Bulaga
Anthony CA, et al. Paper #171. Presented at: American Orthopaedic Society for Sports Medicine Annual Meeting; July 20-23, 2017; Toronto.
Disclosures: Anthony reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.