Preoperative opioid use, non-sports related injury, increased age, chronic pulmonary disease and substance abuse are among the strongest risk factors for opioid use after ACL reconstruction, according to study results presented recently at the American Orthopaedic Society for Sports Medicine Annual Meeting.
“These findings tell us that there is a need for surgeon and patient awareness and education in the management of postoperative opioid usage with ACL reconstruction. We should consider the risk factors for risk stratification and targeted preventative strategies,” says Anita G. Rao, MD, in a media release from Healio Orthopedics.
Using the Kaiser Permanente ACL reconstruction national registry, including the electronic health record pharmacy module, Rao and colleagues identified 21,202 ACL reconstructions from 20,813 patients who had primary elective ACL reconstruction during a 10-year period. They excluded patients with cancer and patients who had other knee surgery during the previous year.
They studied the effect of preoperative and intraoperative risks factors on the number of dispensed opioid medication prescriptions and refills in the early and late postoperative periods. The early postoperative period was defined as 0 to 90 days, and the late postoperative period was defined at 91 to 360 days.
Rao and colleagues found 25.5% of patients used at least one opioid prescription in the 1-year preoperative period. Additionally, 17.7% of patients used two or more opioid prescriptions in the early postoperative period and 2.7% of patients used two or more opioid prescriptions during the late postoperative periods.
Risk factors associated with greater opioid prescriptions in both postoperative periods were preoperative opioid use, age older than 20 years, American Society of Anesthesiologists classification of 3 or more, other activity at the time of injury, repaired cartilage injury, substance abuse and chronic pulmonary disease, which was largely an asthma diagnosis. Risk factors associated with opioid prescription use in the early postoperative period were other race, acute ACL injury, repaired meniscal injury, multi-ligament injury and dementia/psychoses. Risk factors associated with greater opioid prescriptions in the late postoperative period were female patients, hypertension, BMI greater than 25 kg/m2 and motor vehicle accident as the cause of injury.
[Source: Healio Orthopedics]