Opioid Consumption After Rotator Cuff Repair

doi:10.1016/j.arthro.2017.03.016

Arthroscopy: The Journal of Arthroscopic & Related Surgery

Volume 33, Issue 8, August 2017, Pages 1467-1472

https://doi.org/10.1016/j.arthro.2017.03.016 Get rights and content

Purpose

Rising perioperative opioid use in the United States is of increasing concern. The purposes of this study were (1) to define opioid consumption after rotator cuff repair (RCR) in the United States and (2) to evaluate patient factors that may be associated with prolonged opioid use after arthroscopic RCR.

Methods

All arthroscopic RCRs performed between 2007 and 2014 were identified by use of Current Procedural Terminology code (29,827). Patients who filled opioid prescriptions preoperatively were divided into those who filled prescriptions at 1 to 3 months preceding RCR and those who filled opioid prescriptions only in the 1 month preceding RCR. Risk ratios (RRs) were calculated by dividing the cumulative incidence of opioid prescriptions in patients with each patient factor by the cumulative incidence in those without each patient factor.

Results

During the study period, 35,155 arthroscopic RCRs were performed. Of the patients, approximately 43% had filled an opioid prescription in the 3 months before RCR. At 3 months after RCR, patients who filled opioid prescriptions at 1 to 3 months before RCR were 7.45 (95% confidence interval [CI], 6.95-7.98) times more likely to be filling opioid medication prescriptions than those who had not been prescribed opioid medications before surgery; patients who filled opioid prescriptions in the month before RCR were 3.04 (95% CI, 2.8-3.29) times more likely to be filling opioid prescriptions at 3 months after RCR. Patients with psychiatric diagnoses (RR, 1.94; 95% CI, 1.85-2.04), myalgia (RR, 1.67; 95% CI, 1.6-1.75), and low-back pain (RR, 2.09; 95% CI, 2-2.2) were also found to be at risk of filling opioid prescriptions at 3 months postoperatively.

Conclusions

We found approximately 43% of patients undergoing RCR received opioid medications before RCR. Patients who are prescribed narcotics before RCR are at increased risk of postoperative opioid demand. Patients with psychiatric diagnoses, myalgia, and low-back pain may be at increased risk of prolonged opioid use after surgery.

Level of Evidence

Level III, retrospective case-control study.

Section snippets

Methods

The Humana administrative claims database was the source of patient data and was accessed by use of the PearlDiver Technologies Research Program (PearlDiver, Fort Wayne, IN) in April 2015. Patient data are deidentified and Health Insurance Portability and Accountability Act compliant. This study was deemed institutional review board exempt by our institution. The Humana administrative claims database represents 16 million covered persons and includes both privately or commercially insured

Results

Among 35,155 arthroscopic RCRs performed, 47% of patients were female patients and 58.5% of patients were aged between 60 and 74 years. No patients were excluded. Of the patients, approximately 43% (15,230 of 35,155) had filled an opioid prescription in the 3 months before RCR. Of these, 58.9% had been prescribed opioids at 1 to 3 months before RCR and 41.1% had been prescribed preoperative opioids only in the 1 month before RCR. In addition, 11.86% of patients (4,170 of 35,155) had a

Discussion

We found that preoperative opiate use was rampant, at a rate of 43%, with high rates of patients filling opiate prescriptions before surgery. Filling of preoperative opioid prescriptions was the strongest predictor of postoperative opioid use, and patients with psychiatric diagnoses, fibromyalgia, and low-back pain were also filling significantly more narcotic prescriptions after surgery.

Previous authors have considered how preoperative opioid use may influence postoperative opioid demand and

Conclusions

From a large multicenter database, we found approximately 43% of patients undergoing RCR received opioid medications before RCR. Patients who are prescribed narcotics before RCR are at increased risk of postoperative opioid demand. Patients with psychiatric diagnoses, myalgia, and low-back pain may be at increased risk of prolonged opioid use after surgery.

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This systematic review and meta-analysis indicates that NSAIDs do not affect healing rate after arthroscopic rotator cuff repair, but they do significantly improve postoperative pain and functional outcomes. No significant difference was seen in pain or functional outcomes with the use of COX-2 inhibitors.
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Amidst a national opioid crisis, increased focus has been placed on reducing opioid consumption. Novel multimodal pain protocols including the use of liposomal bupivacaine (LB) have shown success in minimizing opioid usage after orthopedic surgery. There is disputing evidence of the effectiveness of LB use in shoulder surgery and the purpose of our study was to analyze the risk factors and determinants of LB failure for postoperative pain control after orthopedic shoulder surgeries.
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Performing surgeon, gender, history of opioid use, and prior surgeries were all identified as strong, independent predictor variables of LB failure. In this study, performing surgeon is likely indicative of the impact of differences in patient education on postoperative pain expectations and alternate treatments. We recommend that surgeons incorporate further preoperative patient education, and to take into account, the specific risk factors when deciding to incorporate LB into their multimodal postoperative pain management plan for patients undergoing shoulder surgery.
Increase in Deltoid Compartment Pressures Immediately After Arthroscopic Rotator Cuff Repair Does Not Significantly Affect Postoperative Opioid Consumption
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To investigate the association between changes in individual (anterior, lateral, and posterior) and overall deltoid compartment pressures and postoperative opioid consumption up to 14 days after primary double-row arthroscopic rotator cuff repair (ARCR).
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: The authors report the following potential conflicts of interest or sources of funding: M.B. receives support from Arthrex (consultant). B.R.W. receives support from Arthrex (paid consultant for MEDCON).

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Original ArticleOpioid Consumption After Rotator Cuff Repair

Purpose

Methods

Results

Conclusions

Level of Evidence

Section snippets

Methods

Results

Discussion

Conclusions

J Shoulder Elbow Surg

Arthroscopy

Mayo Clin Proc

Opioid epidemic in the United States

Pain Physician

Reducing the risks of relief—The CDC opioid-prescribing guideline

N Engl J Med

The undertreatment of pain: Scientific, clinical, cultural, and philosophical factors

Med Health Care Philos

The world medicines situation 2011: Access to controlled medicines

Characteristics of opioid prescriptions in 2009

JAMA

Higher opioid doses predict poorer functional outcome in patients with chronic disabling occupational musculoskeletal disorders

J Bone Joint Surg Am

Original Article
Opioid Consumption After Rotator Cuff Repair