Risk Factors for Postoperative Opioid Use in Arthroscopic Shoulder Labrum Surgery.
Jildeh TR, Taylor KA, Tramer JS, Khalil LS, Hasan L, Okoroha KR, and Moutzouros V. Risk Factors for Postoperative Opioid Use in Arthroscopic Shoulder Labrum Surgery. Arthroscopy 2020.
PURPOSE: The purpose of this study was to determine the correlation between pre- and postoperative opioid use in patients undergoing arthroscopic shoulder labral repair, as well as patient risk factors associated with increased postoperative opioid use following the procedure.
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 nonusers, acute users, or chronic users based on preoperative consumption. Patient demographics, injury characteristics, surgical interventions, and postoperative opioid use for the first 12 months after surgery were then analyzed.
RESULTS: A total of 340 patients were included in this study. The average age was 26.3 years old (range 13-68) and the average body mass index was 27.5 kg/m(2) (range 18.4-45.0). Preoperative opioid users (acute and chronic) were found to continue to receive opioid medications at extended time points beyond 2 months postoperatively compared to non-users (P < .001). Patients with intraoperatively identified SLAP tears experienced more preoperative pain, and required greater postoperative opioid prescriptions (P <.018). When stratifying for other common shoulder instability injury patterns, there were no differences between the number of postoperative opioid prescriptions filled and presence 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).
CONCLUSIONS: In patients undergoing arthroscopic labral surgery, the chronicity of preoperative opioid use, number of concomitant procedures at the time of initial surgery, and presence of biceps tenodesis were found to significantly increase postoperative opioid demand. Orthopaedic surgeons should recognize risk factors for increased opioid use postoperatively and adapt treatment strategies and patient counseling accordingly.
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