Risk Factors for Postoperative Opioid Use in Arthroscopic Meniscal Surgery.

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PURPOSE: (1) To evaluate the influence of preoperative opioid use on postoperative consumption after arthroscopic meniscal surgery and (2) to determine preoperative patient factors associated with increased opioid use after meniscal surgery.

METHODS: We performed a retrospective review of all patients with a primary diagnosis of a meniscal tear at a single institution between August 2013 and February 2017. Patients were classified as opioid nonusers if they had not received any opioid medications in the 3 months before meniscal surgery, as acute users if they received at least 1 opioid prescription within 1 month preceding meniscal surgery, or as chronic users if they received at least 1 opioid prescription within 3 months preceding meniscal surgery. Clinical records were reviewed for postoperative opioid use within a year after surgery. We also recorded patient demographic characteristics and the degree of knee osteoarthritis at the time of surgery using the Outerbridge classification.

RESULTS: A total of 735 patients were included. The average age was 46.7 years (range, 12-79 years), and the average body mass index was 30.2 ± 6.2 (range, 13.3-55.4). Patients who were acute or chronic opioid users preoperatively were more likely to continue to use opioids beyond 1 month postoperatively (P < .001). A higher percentage of patients with advanced osteoarthritis (Outerbridge grade 3 or 4) were found to continue to use opioids at all time points beyond the first postoperative month (P < .05). Pair-wise comparisons showed that the number of total opioid prescriptions filled was significantly higher in the group with Outerbridge grade 1 or 2 and the group with Outerbridge grade 3 or 4 than the group with Outerbridge grade 0 (P = .023 and P = .014, respectively). No significant difference in postoperative opioid use was noted when we compared meniscal repair versus resection, primary procedure versus revision, different tear types, or concomitant procedures.

CONCLUSIONS: In patients undergoing arthroscopic meniscal surgery, the chronicity of preoperative opioid intake and degree of knee osteoarthritis were found to have a significant effect on postoperative opioid use.

LEVEL OF STUDY: Level III, retrospective comparative study.

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