Persistent post-operative opioid use following hip arthroscopy is common and is associated with pre-operative opioid use and age
Purpose Hip arthroscopy utilization continues to increase worldwide. Post-operative pain management is essential to allow appropriate rehabilitation. While multimodal analgesic protocols have been described, consensus agreement is lacking and opioid analgesia remains a mainstay of treatment. Unfortu...
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| Veröffentlicht in: | Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA sports traumatology, arthroscopy : official journal of the ESSKA, 2021-08, Vol.29 (8), p.2437-2445 |
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| container_title | Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA |
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| creator | Degen, Ryan M. McClure, J. Andrew Le, Britney Welk, Blayne Marsh, Jacquelyn |
| description | Purpose
Hip arthroscopy utilization continues to increase worldwide. Post-operative pain management is essential to allow appropriate rehabilitation. While multimodal analgesic protocols have been described, consensus agreement is lacking and opioid analgesia remains a mainstay of treatment. Unfortunately, the risk of persistent opioid use among opioid-naïve and non-naïve patients following hip arthroscopy remains unclear. Therefore, the purpose of this study was to identify rates of persistent post-operative opioid use, as well as to identify factors associated with persistent use.
Methods
A retrospective cohort study was conducted using linked administrative data from Ontario, Canada. Participants were adults who underwent hip arthroscopy between 2013 and 2018. Patients 60 years of age as well as those who had undergone prior hip arthroscopy were excluded. The primary exposure was whether patients had filled ≥ 2 opioid prescriptions within 1 year prior to their hip arthroscopy to define the opioid naïve and non-naïve populations. The primary outcome was persistent opioid use, defined as 2 + prescriptions filled between 9 and 15 months post-op. A regression analysis was performed to identify factors associated with persistent opioid usage.
Results
Of the 1909 patients, 1525 (79.9%) were opioid-naïve, while 384 (20.1%) had a prior history of opioid use within 1 year of surgery. 224 patients (11.7%) demonstrated persistent opioid use, with ≥ 2 prescriptions filled between 9 and 15 months post-op. Of those, 42 (18.8%) cases were among opioid-naïve patients, while the remaining 182 (81.2%) were among non-naïve patients. The risk of persistent post-operative use was significantly higher in those with prior opioid use (OR 31.95, 95% CI 22.15–46.09;
p
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| doi_str_mv | 10.1007/s00167-021-06511-0 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2494875139</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2554137716</sourcerecordid><originalsourceid>FETCH-LOGICAL-c375t-476fc18a0b0ce36d8564938e70d8434c20c611d8a5452b55cc650895f0b78bde3</originalsourceid><addsrcrecordid>eNp9kU2L1TAUhoMoznX0D7iQgBs31ZPvdimDOsKALnQd0vT03gxtU5PUYXb-dHPnjgoibvJBnvOeJA8hzxm8ZgDmTQZg2jTAWQNasTo-IDsmhWiMkOYh2UEnecNB6TPyJOdrgLqU3WNyJoSWWhi-Iz8-Y8ohF1wKXWMuTVwxuRK-I41riGGgW0Y6xmmKN2HZ00NYqUvlkGL2cb2lIVMf5zku1C3Dcedyjj64ggO9CeVA14T_zjzybo9PyaPRTRmf3c_n5Ov7d18uLpurTx8-Xry9arwwqjTS6NGz1kEPHoUe2uNLRIsGhlYK6Tl4zdjQOiUV75XyXitoOzVCb9p-QHFOXp1y1xS_bZiLnUP2OE1uwbhly2UnW6OY6Cr68i_0Om5pqbezXCnJhDFMV4qfKF__Iicc7ZrC7NKtZWCPfuzJj61-7J0fC7XoxX301s84_C75JaQC4gTkerTsMf3p_Z_Yn28inC4</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2554137716</pqid></control><display><type>article</type><title>Persistent post-operative opioid use following hip arthroscopy is common and is associated with pre-operative opioid use and age</title><source>Wiley Online Library Journals Frontfile Complete</source><source>SpringerLink Journals</source><creator>Degen, Ryan M. ; McClure, J. Andrew ; Le, Britney ; Welk, Blayne ; Marsh, Jacquelyn</creator><creatorcontrib>Degen, Ryan M. ; McClure, J. Andrew ; Le, Britney ; Welk, Blayne ; Marsh, Jacquelyn</creatorcontrib><description>Purpose
Hip arthroscopy utilization continues to increase worldwide. Post-operative pain management is essential to allow appropriate rehabilitation. While multimodal analgesic protocols have been described, consensus agreement is lacking and opioid analgesia remains a mainstay of treatment. Unfortunately, the risk of persistent opioid use among opioid-naïve and non-naïve patients following hip arthroscopy remains unclear. Therefore, the purpose of this study was to identify rates of persistent post-operative opioid use, as well as to identify factors associated with persistent use.
Methods
A retrospective cohort study was conducted using linked administrative data from Ontario, Canada. Participants were adults who underwent hip arthroscopy between 2013 and 2018. Patients < 18 or > 60 years of age as well as those who had undergone prior hip arthroscopy were excluded. The primary exposure was whether patients had filled ≥ 2 opioid prescriptions within 1 year prior to their hip arthroscopy to define the opioid naïve and non-naïve populations. The primary outcome was persistent opioid use, defined as 2 + prescriptions filled between 9 and 15 months post-op. A regression analysis was performed to identify factors associated with persistent opioid usage.
Results
Of the 1909 patients, 1525 (79.9%) were opioid-naïve, while 384 (20.1%) had a prior history of opioid use within 1 year of surgery. 224 patients (11.7%) demonstrated persistent opioid use, with ≥ 2 prescriptions filled between 9 and 15 months post-op. Of those, 42 (18.8%) cases were among opioid-naïve patients, while the remaining 182 (81.2%) were among non-naïve patients. The risk of persistent post-operative use was significantly higher in those with prior opioid use (OR 31.95, 95% CI 22.15–46.09;
p
< 0.0001). Regression analysis confirmed that pre-operative opioid use (OR 23.79, 95% CI 17.06–33.17;
p
< 0.0001) and older age (OR 1.04, 95% CI 1.02–1.05,
p
< 0.0001) were associated with increased risk of persistent post-operative opioid use.
Conclusion
Following hip arthroscopy, persistent opioid use is common. New persistent use was identified in 2.7% of opioid-naïve patients, compared with continued use in 47.4% of non-naïve patients. Pre-operative opioid use and older age were associated with the greater risk of persistent post-operative opioid use.
Level of evidence
Level III.</description><identifier>ISSN: 0942-2056</identifier><identifier>EISSN: 1433-7347</identifier><identifier>DOI: 10.1007/s00167-021-06511-0</identifier><identifier>PMID: 33646372</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Age ; Analgesia ; Analgesics ; Arthroscopy ; Hip ; Medicine ; Medicine & Public Health ; Narcotics ; Opioids ; Orthopedics ; Pain ; Pain perception ; Patients ; Regression analysis ; Rehabilitation ; Risk ; Sports Medicine ; Surgery</subject><ispartof>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2021-08, Vol.29 (8), p.2437-2445</ispartof><rights>European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2021</rights><rights>European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2021.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-476fc18a0b0ce36d8564938e70d8434c20c611d8a5452b55cc650895f0b78bde3</citedby><cites>FETCH-LOGICAL-c375t-476fc18a0b0ce36d8564938e70d8434c20c611d8a5452b55cc650895f0b78bde3</cites><orcidid>0000-0001-9981-6074</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00167-021-06511-0$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00167-021-06511-0$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27903,27904,41467,42536,51297</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33646372$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Degen, Ryan M.</creatorcontrib><creatorcontrib>McClure, J. Andrew</creatorcontrib><creatorcontrib>Le, Britney</creatorcontrib><creatorcontrib>Welk, Blayne</creatorcontrib><creatorcontrib>Marsh, Jacquelyn</creatorcontrib><title>Persistent post-operative opioid use following hip arthroscopy is common and is associated with pre-operative opioid use and age</title><title>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA</title><addtitle>Knee Surg Sports Traumatol Arthrosc</addtitle><addtitle>Knee Surg Sports Traumatol Arthrosc</addtitle><description>Purpose
Hip arthroscopy utilization continues to increase worldwide. Post-operative pain management is essential to allow appropriate rehabilitation. While multimodal analgesic protocols have been described, consensus agreement is lacking and opioid analgesia remains a mainstay of treatment. Unfortunately, the risk of persistent opioid use among opioid-naïve and non-naïve patients following hip arthroscopy remains unclear. Therefore, the purpose of this study was to identify rates of persistent post-operative opioid use, as well as to identify factors associated with persistent use.
Methods
A retrospective cohort study was conducted using linked administrative data from Ontario, Canada. Participants were adults who underwent hip arthroscopy between 2013 and 2018. Patients < 18 or > 60 years of age as well as those who had undergone prior hip arthroscopy were excluded. The primary exposure was whether patients had filled ≥ 2 opioid prescriptions within 1 year prior to their hip arthroscopy to define the opioid naïve and non-naïve populations. The primary outcome was persistent opioid use, defined as 2 + prescriptions filled between 9 and 15 months post-op. A regression analysis was performed to identify factors associated with persistent opioid usage.
Results
Of the 1909 patients, 1525 (79.9%) were opioid-naïve, while 384 (20.1%) had a prior history of opioid use within 1 year of surgery. 224 patients (11.7%) demonstrated persistent opioid use, with ≥ 2 prescriptions filled between 9 and 15 months post-op. Of those, 42 (18.8%) cases were among opioid-naïve patients, while the remaining 182 (81.2%) were among non-naïve patients. The risk of persistent post-operative use was significantly higher in those with prior opioid use (OR 31.95, 95% CI 22.15–46.09;
p
< 0.0001). Regression analysis confirmed that pre-operative opioid use (OR 23.79, 95% CI 17.06–33.17;
p
< 0.0001) and older age (OR 1.04, 95% CI 1.02–1.05,
p
< 0.0001) were associated with increased risk of persistent post-operative opioid use.
Conclusion
Following hip arthroscopy, persistent opioid use is common. New persistent use was identified in 2.7% of opioid-naïve patients, compared with continued use in 47.4% of non-naïve patients. Pre-operative opioid use and older age were associated with the greater risk of persistent post-operative opioid use.
Level of evidence
Level III.</description><subject>Age</subject><subject>Analgesia</subject><subject>Analgesics</subject><subject>Arthroscopy</subject><subject>Hip</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Narcotics</subject><subject>Opioids</subject><subject>Orthopedics</subject><subject>Pain</subject><subject>Pain perception</subject><subject>Patients</subject><subject>Regression analysis</subject><subject>Rehabilitation</subject><subject>Risk</subject><subject>Sports Medicine</subject><subject>Surgery</subject><issn>0942-2056</issn><issn>1433-7347</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kU2L1TAUhoMoznX0D7iQgBs31ZPvdimDOsKALnQd0vT03gxtU5PUYXb-dHPnjgoibvJBnvOeJA8hzxm8ZgDmTQZg2jTAWQNasTo-IDsmhWiMkOYh2UEnecNB6TPyJOdrgLqU3WNyJoSWWhi-Iz8-Y8ohF1wKXWMuTVwxuRK-I41riGGgW0Y6xmmKN2HZ00NYqUvlkGL2cb2lIVMf5zku1C3Dcedyjj64ggO9CeVA14T_zjzybo9PyaPRTRmf3c_n5Ov7d18uLpurTx8-Xry9arwwqjTS6NGz1kEPHoUe2uNLRIsGhlYK6Tl4zdjQOiUV75XyXitoOzVCb9p-QHFOXp1y1xS_bZiLnUP2OE1uwbhly2UnW6OY6Cr68i_0Om5pqbezXCnJhDFMV4qfKF__Iicc7ZrC7NKtZWCPfuzJj61-7J0fC7XoxX301s84_C75JaQC4gTkerTsMf3p_Z_Yn28inC4</recordid><startdate>20210801</startdate><enddate>20210801</enddate><creator>Degen, Ryan M.</creator><creator>McClure, J. Andrew</creator><creator>Le, Britney</creator><creator>Welk, Blayne</creator><creator>Marsh, Jacquelyn</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7RV</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-9981-6074</orcidid></search><sort><creationdate>20210801</creationdate><title>Persistent post-operative opioid use following hip arthroscopy is common and is associated with pre-operative opioid use and age</title><author>Degen, Ryan M. ; McClure, J. Andrew ; Le, Britney ; Welk, Blayne ; Marsh, Jacquelyn</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-476fc18a0b0ce36d8564938e70d8434c20c611d8a5452b55cc650895f0b78bde3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Age</topic><topic>Analgesia</topic><topic>Analgesics</topic><topic>Arthroscopy</topic><topic>Hip</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Narcotics</topic><topic>Opioids</topic><topic>Orthopedics</topic><topic>Pain</topic><topic>Pain perception</topic><topic>Patients</topic><topic>Regression analysis</topic><topic>Rehabilitation</topic><topic>Risk</topic><topic>Sports Medicine</topic><topic>Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Degen, Ryan M.</creatorcontrib><creatorcontrib>McClure, J. Andrew</creatorcontrib><creatorcontrib>Le, Britney</creatorcontrib><creatorcontrib>Welk, Blayne</creatorcontrib><creatorcontrib>Marsh, Jacquelyn</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Physical Education Index</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Degen, Ryan M.</au><au>McClure, J. Andrew</au><au>Le, Britney</au><au>Welk, Blayne</au><au>Marsh, Jacquelyn</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Persistent post-operative opioid use following hip arthroscopy is common and is associated with pre-operative opioid use and age</atitle><jtitle>Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA</jtitle><stitle>Knee Surg Sports Traumatol Arthrosc</stitle><addtitle>Knee Surg Sports Traumatol Arthrosc</addtitle><date>2021-08-01</date><risdate>2021</risdate><volume>29</volume><issue>8</issue><spage>2437</spage><epage>2445</epage><pages>2437-2445</pages><issn>0942-2056</issn><eissn>1433-7347</eissn><abstract>Purpose
Hip arthroscopy utilization continues to increase worldwide. Post-operative pain management is essential to allow appropriate rehabilitation. While multimodal analgesic protocols have been described, consensus agreement is lacking and opioid analgesia remains a mainstay of treatment. Unfortunately, the risk of persistent opioid use among opioid-naïve and non-naïve patients following hip arthroscopy remains unclear. Therefore, the purpose of this study was to identify rates of persistent post-operative opioid use, as well as to identify factors associated with persistent use.
Methods
A retrospective cohort study was conducted using linked administrative data from Ontario, Canada. Participants were adults who underwent hip arthroscopy between 2013 and 2018. Patients < 18 or > 60 years of age as well as those who had undergone prior hip arthroscopy were excluded. The primary exposure was whether patients had filled ≥ 2 opioid prescriptions within 1 year prior to their hip arthroscopy to define the opioid naïve and non-naïve populations. The primary outcome was persistent opioid use, defined as 2 + prescriptions filled between 9 and 15 months post-op. A regression analysis was performed to identify factors associated with persistent opioid usage.
Results
Of the 1909 patients, 1525 (79.9%) were opioid-naïve, while 384 (20.1%) had a prior history of opioid use within 1 year of surgery. 224 patients (11.7%) demonstrated persistent opioid use, with ≥ 2 prescriptions filled between 9 and 15 months post-op. Of those, 42 (18.8%) cases were among opioid-naïve patients, while the remaining 182 (81.2%) were among non-naïve patients. The risk of persistent post-operative use was significantly higher in those with prior opioid use (OR 31.95, 95% CI 22.15–46.09;
p
< 0.0001). Regression analysis confirmed that pre-operative opioid use (OR 23.79, 95% CI 17.06–33.17;
p
< 0.0001) and older age (OR 1.04, 95% CI 1.02–1.05,
p
< 0.0001) were associated with increased risk of persistent post-operative opioid use.
Conclusion
Following hip arthroscopy, persistent opioid use is common. New persistent use was identified in 2.7% of opioid-naïve patients, compared with continued use in 47.4% of non-naïve patients. Pre-operative opioid use and older age were associated with the greater risk of persistent post-operative opioid use.
Level of evidence
Level III.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>33646372</pmid><doi>10.1007/s00167-021-06511-0</doi><tpages>9</tpages><orcidid>https://orcid.org/0000-0001-9981-6074</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0942-2056 |
| ispartof | Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2021-08, Vol.29 (8), p.2437-2445 |
| issn | 0942-2056 1433-7347 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2494875139 |
| source | Wiley Online Library Journals Frontfile Complete; SpringerLink Journals |
| subjects | Age Analgesia Analgesics Arthroscopy Hip Medicine Medicine & Public Health Narcotics Opioids Orthopedics Pain Pain perception Patients Regression analysis Rehabilitation Risk Sports Medicine Surgery |
| title | Persistent post-operative opioid use following hip arthroscopy is common and is associated with pre-operative opioid use and age |
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