A Prospective Assessment of Opioid Utilization Post- Operatively in Orthopaedic Sports Medicine Surgeries

Document Type : RESEARCH PAPER

Authors

Department of Orthopaedic Surgery, St. Louis University, St. Louis, MO, USA

Abstract

Background: The healthcare system is plagued finding the balance between opioid use and abuse. Orthopaedic
surgeons are expected to curtail the number of opioids prescribed in order to lower opioid abuse. We sought to
prospectively evaluate opioid consumption following a wide range of sports orthopaedic surgical procedures to
determine utilization patterns.
Methods: All patients receiving procedures within a one-year period were consented and then called daily for one
week followed by weekly for up to two months or until the patients no longer were taking their opioid medication. We
studied the number of opioids patient’s took postoperatively and also collected information in regards to the patient
and the surgical procedure.
Results: Included were 223 patients with a mean age of 32.9 years (range, 11 to 82). Surgeons prescribed a
mean total of 59.5 pills, and patients reported consuming a mean total of 20.9 pills, resulting in a utilization rate
of 40%. 94.4% of patients received no education on how to properly dispose of unused opioids. The mean SANE
score was 53.9. The mean Pain Catastrophizing Scale score was 15.1. The mean Opioid Risk Tool was 3.3. The
procedures were broken down into: 47.5% ligamentous knee repair, 18.4% shoulder arthroscopy/other shoulder,
7.6% meniscus, 7.6% shoulder arthroplasty, 5.4% distal biceps, 4.0% lower leg (ankle/foot/tibia) and 4.0% shoulder
ORIF.
Conclusion: Over-prescribing opioids after sports orthopaedic surgeries is widespread. In this study, we found
that patients are being prescribed 2.48 times greater opioid medications than needed following sports orthopaedic
surgical procedures. We recommend surgeons take care when prescribing postoperative pain control and consider
customizing their opioid prescriptions on the basis of prior opioid usage, anatomic location and procedure type.
We also recommend educating the patients on proper disposal of excess opioids and consider involving pain
management for patients likely to require prolonged opioid usag e.
Level of evidence: II

Keywords


1. Morris BJ, Mir HR. The opioid epidemic: impact on
orthopaedic surgery. J Am Acad Orthop Surg. 2015;
23(5):267-271.
2. Kim N, Matzon JL, Abboudi J, Jones C, Kirkpatrick
W, Leinberry CF, et al. A prospective evaluation of
opioid utilization after upper-extremity surgical
procedures: identifying consumption patterns and
determining prescribing guidelines. J Bone Joint Surg
Am. 2016; 89:)20(98.
3. Shrank WH. Our bulging medicine cabinets—the
other side of medication nonadherence. N Engl J Med.
2011; 3-1591:)17(364.
4. Pasero C, McCaffery M. Orthopaedic postoperative pain
management. J Perianesth Nurs. 2007; 22(3):160-174.
5. Sullivan MJ, Bishop SR, Pivik J. The pain catastrophizing
scale: development and validation. Psychological
assessment. 1995; 7(4):524.
6. Webster LR, Webster RM. Predicting aberrant
behaviors in opioid-treated patients: preliminary
validation of the Opioid Risk Tool. Pain Med.
2005; 42-432:)6(6.
7. Seber GA, Lee AJ. Linear regression analysis. John
Wiley & Sons; 2012.
8. Ben-Gal I. Outlier detection. InData mining and
knowledge discovery handbook 2005 (pp. 131-146).
Springer, Boston, MA.
9. James PT, Leach R, Kalmara E, Shayeghi M. The
worldwide obesity epidemic. Obes Res. 2001;
9(11):33-228.
10. Nuttall FQ. Body mass index: obesity, BMI, and health:
a critical review. Nutr Today. 2015; 50(3):117.
11. Seth P, Rudd RA, Noonan RK, Haegerich TM. Quantifying
the epidemic of prescription opioid overdose deaths.
Am J Public Health. 2018; 108(4):500-2.
12. Morone NE, Weiner DK. Pain as the fifth vital sign:
exposing the vital need for pain education. Clin Ther.
2013; 35(11):1728-32.
13. Labrum JT, Ilyas AM. The opioid epidemic:
postoperative pain management strategies in
orthopaedics. J Bone Joint Surg Am. 2017; 14:)8(5.
14. Westermann RW, Anthony CA, Bedard N, Glass N,
Bollier M, Hettrich, CM, et al. Opioid consumption after
rotator cuff repair. Arthroscopy. 2017; 33(8):1467-72.
15. Morris BJ, Laughlin MS, Elkousy HA, Gartsman GM,
Edwards TB. Preoperative opioid use and outcomes
after reverse shoulder arthroplasty. J Shoulder Elb
Surg. 2015; 6-11:)1(24.
16. Rao AG, Chan PH, Prentice HA, Paxton EW, Navarro RA,
Dillon MT, et al. Risk factors for postoperative opioid
use after elective shoulder arthroplasty. J Shoulder
Elb Surg. 2018; 8-1960:)11(27.
17. Clarke H, Soneji N, Ko DT, Yun L, Wijeysundera DN.
Rates and risk factors for prolonged opioid use after
major surgery: population based cohort study. Br
Med J. 2014; 1251:)1(348.
18. Jiang X, Orton M, Feng R, Hossain E, Malhotra NR, Zager
EL, et al. Chronic opioid usage in surgical patients in
a large academic center. Ann Surg. 2017; 722:)4(265.
19. Dziechciaż M, Balicka-Adamik L, Filip R. The
problem of pain in old age. Ann Agric Environ Med.
2013; 8-35:)1(1.
20. Thielke SM, Simoni-Wastila L, Edlund MJ, DeVries A,
Martin BC, Braden JB, et al. Age and sex trends in longterm
opioid use in two large American health systems
between 2000 and 2005. Pain Med. 2010; 56-248:)2(11.
21. O’Connor CM, Ring D. Correlation of Single Assessment
Numeric Evaluation (SANE) with other Patient
Reported Outcome Measures (PROMs). Arch Bone Jt
Surg. 2019; 303:)4(7.
22. Jones T, Lookatch S, Grant P, McIntyre J, Moore T.
Further validation of an opioid risk assessment
tool: the brief risk interview. J Opioid Manag.
2014; 10(5):353-64.
23. Nuckols TK, Anderson L, Popescu I, Diamant AL, Doyle
B, Di Capua P, et al. Opioid prescribing: a systematic
review and critical appraisal of guidelines for chronic
pain. Ann Intern Med. 2014; 47-38:)1(160.
24. Sullivan M, Tanzer M, Stanish W, Fallaha M, Keefe
FJ, Simmonds M, et al. Psychological determinants
of problematic outcomes following total knee
arthroplasty. Pain. 2009; 143(2):123-9.
25. Rodgers J, Cunningham K, Fitzgerald K, Finnerty
E. Opioid consumption following outpatient upper
extremity surgery. J Hand Surg. 2012; 50-645:)4(37.
26. Bicket MC, Long JJ, Pronovost PJ, Alexander GC,
Wu CL. Prescription opioid analgesics commonly
unused after surgery: a systematic review. JAMA Surg.
2017; 71-1066:)11(152.
27. Bartels K, Mayes LM, Dingmann C, Bullard KJ, Hopfer
CJ, Binswanger IA. Opioid use and storage patterns
by patients after hospital discharge following
surgery. PloS One. 2016; 11(1):1-10.
28. Disposal of unused medicines: what you should
know [Internet]. [Place unknown]: Food and Drug
Administration; 2015 [updated 2019; cited 2020 May
15]. Available from: https://www.fda.gov/drugs/
safe-disposal-medicines/.
29. Wickstrom G, Bendix T. The Hawthorne effect-what
did the original Hawthorne studies actually show?
Scand J Work Env Hea. 2000; 26(1):363-7.
Volume 9, Issue 5
September and October 2021
Pages 503-511
  • Receive Date: 14 June 2020
  • Revise Date: 08 December 2020
  • Accept Date: 19 December 2020
  • First Publish Date: 31 December 2020