Risk Factors for Postoperative Opioid Use in Arthroscopic Labrum Surgery
Resident PGY 3
Henry Ford Hospital
Background: Arthroscopic shoulder labral surgery is a commonly performed outpatient procedure in which narcotic medications can be used to manage postoperative pain. The purpose of this study was to determine the correlation between preoperative and postoperative opioid use in patients undergoing arthroscopic shoulder labral surgery. Additionally, we aimed to identify patient risk factors associated with increased postoperative opioid use following their labral surgery.
Methods: A retrospective review of all patients undergoing arthroscopic shoulder labral surgery at a single institution between August 2013 and November 2017 was performed. Patients were stratified as opioid non-users, acute users, and chronic users based on preoperative consumption. Patient demographics, injury characteristics, surgical interventions, and postoperative opioid use for the first 12 months after surgery were documented. Prescriptions were corroborated with the Michigan Automated Prescription System for monitoring controlled substances. Categorical data were compared between groups using chi-square tests or Fisher’s exact tests. Continuous data were compared between 2-level groups using Wilcoxon rank-sum tests and between >2-level group using Kruskal-Wallis tests due to non-normal distributions and small group sizes. Relative risk and 95% CIs were obtained using PROC FREQ. Statistical significance was set at P < .05. All analyses were performed using SAS 9.4 (SAS Institute Inc, Cary, NC).
Results: A total of 360 patients were included. The average age was 26.6 years old (range 13-68) and the average body mass index was 27.6 kg/m2 (range 18.4-45.0). Preoperative opioid users (acute and chronic) were found to require opioid medications at extended time points postoperatively compared to non-users (P < .001). Preoperative users were 4.6 and 6.1 more times likely to refill a narcotic prescription postoperatively at 2 and 3 months, respectively. A higher percentage of patients who underwent biceps tenotomy or tenodesis at the time of their labral surgery required opioid prescriptions beyond 1 month postoperatively (P < .05). Upon stratifying for subtypes of sequalae, there were no differences between the number of postoperative opioid prescriptions filled and incidence of Bankart, Hill Sachs, Reverse Hill Sachs, anterior labroligamentous periosteal sleeve avulsion, glenolabral articular disruption, or humeral avulsion of the glenohumeral ligament lesions, (P > .05).
Conclusion: In patients undergoing arthroscopic labral surgery, the chronicity of preoperative opioid use and presence of concomitant biceps interventions were found to significantly increase postoperative opioid demand. Orthopaedic surgeons should recognize these risk factors for increased opioid use postoperatively and counsel their patients accordingly.
Taylor, Kevin; Jildeh, Toufic; Khalil, Lafi S; Tramer, Joseph S; Hasan, Laith; Okoroha, Kelechi R.; and Moutzouros, Vasilios, "Risk Factors for Postoperative Opioid Use in Arthroscopic Labrum Surgery" (2019). Clinical Research. 48.