Faculty Collaboration Database

Influence of preoperative opioid use on postoperative outcomes and opioid use after arthroscopic rotator cuff repair. J Shoulder Elbow Surg 2019 Mar;28(3):453-460

Date

12/07/2018

Pubmed ID

30503333

DOI

10.1016/j.jse.2018.08.036

Scopus ID

2-s2.0-85057392166 (requires institutional sign-in at Scopus site)   48 Citations

Abstract

BACKGROUND: Recent orthopedic research has questioned the effect of opioid use on surgical outcomes. This study investigated this in the context of arthroscopic rotator cuff repair. We hypothesized that preoperative opioid use would be associated with inferior outcomes and greater postoperative opioid requirements.

METHODS: A database query identified adult patients with full-thickness or partial-thickness supraspinatus tears surgically treated between 2011 and 2015. Preoperative and postoperative outcomes scores (active range of motion [AROM], American Shoulder and Elbow Surgeons [ASES], Constant scores, Simple Shoulder Test [SST], and visual analog scale [VAS] for pain) and postoperative opioid use were retrospectively recorded. Patients with less than 2 years of follow-up data at the time of the retrospective review were contacted for prospective ASES, SST, and VAS data collection.

RESULTS: A total of 200 patients, 44 of whom received opioids preoperatively, were identified for inclusion. Patients prescribed preoperative opioids had consistently inferior preoperative and postoperative outcomes scores; however, the magnitudes of improvement were not significantly different between groups. Postoperatively, patients in the preoperative opioid group received 1.91 (95% confidence interval, 1.31-2.78) times more opioids over a postoperative course of treatment that was 2.73 (95% confidence interval, 1.62-4.59) times longer. In addition to having a greater proportion of women, this group also had significantly higher rates of certain comorbidities, including back pain, depression, degenerative joint disease, and chronic pain conditions.

CONCLUSIONS: All patients demonstrated significant improvements in outcomes scores after surgical repair that were not significantly different between groups. However, patients taking opioids preoperatively did not ultimately reach the same level of functionality and had substantially greater opioid requirements postoperatively.

Author List

Williams BT, Redlich NJ, Mickschl DJ, Grindel SI

Author

Steven I. Grindel MD Professor in the Orthopaedic Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Analgesics, Opioid
Arthroscopy
Databases, Factual
Drug Administration Schedule
Female
Humans
Male
Middle Aged
Pain Measurement
Pain, Postoperative
Preoperative Period
Prospective Studies
Range of Motion, Articular
Retrospective Studies
Rotator Cuff Injuries
Surveys and Questionnaires