It might seem logical that preoperative opioid use is linked to postoperative use. But researchers set out to dig into the details. Their study, “Prescription Opioid Use Before and After Hip Arthroscopy: A Caution to Prescribers,” was published in the January 4, 2019 edition of Arthroscopy.
Co-author Kyle Duchman, M.D. an orthopedic surgeon with the University of Iowa Hospitals and Clinics in Iowa City, described the rationale and purpose of the study to OTW, “The opioid epidemic in the United States has been well documented. Prescription opioid abuse and diversion certainly contribute to this epidemic, and as physicians, we play an important role in prescription opioid utilization. Unfortunately, despite the increased awareness surrounding prescription opioid utilization, there remains little evidence to guide appropriate prescription opioid use in the in perioperative period.”
To help develop evidence to guide opioid use in arthroscopy patients, the authors collected data for 1,208 patients undergoing hip arthroscopy. In the data, they observed chronic and acute preoperative opioid use in 24.9% and 17.3% of patients, respectively. The researchers noted that chronic preoperative opioid use was more prevalent in obese patients, patients ≥ 50 years of age, and patients with preexisting anxiety and/or depression.
According to the authors, “In multivariate analysis, chronic preoperative opioid utilization was the strongest predictor of opioid prescription filling at 3, 6, 8, and 12 months postoperatively, whereas preexisting anxiety and/or depression and obesity were additionally identified as predictors of prolonged postoperative opioid utilization.”
Dr. Duchman told OTW, “Patients who used prescription opioids prior to surgery, regardless of the reason for prescription opioid use, were more likely to continue using prescription opioids one year after surgery. This is important to consider. If we are able to restrict initial opioid use, we may be able to avoid the detrimental individual and societal negative effects associated with their use.”
“For patients with conditions that may be chronic or present for a long time prior to formal diagnosis, there is likely little role for pain management with prescription opioid medications. The current study reveals that even a short-term opioid prescription can put patients at risk for prolonged use.”
“As orthopedic surgeons, one of our primary goals is to restore function. Pain certainly can play a role in limiting function. However, when considering pain relieving strategies, we must consider the risks and benefits of those medications. Orthopedic surgeons remain one of the most frequent prescribers of prescription opioids in the United States, and we therefore have an important role in the responsible use and distribution of these medications.”
