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Preoperative opioid consumption may yield greater opioid requirements after rotator cuff repair
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Despite significant postoperative improvements, patients who were prescribed opioids prior to rotator cuff repair had a lower level of functionality and substantially greater opioid requirements postoperatively than patients who were not prescribed opioids preoperatively, according to results.
Steven I. Grindel, MD, and colleagues retrospectively recorded preoperative and postoperative outcomes scores and postoperative opioid use among 200 patients with full-thickness or partial-thickness supraspinatus tears who underwent rotator cuff repair. Of these patients, 44 were prescribed opioids preoperatively.
Results showed consistently inferior preoperative and postoperative outcomes scores among patients prescribed preoperative opioids. However, researchers found no significant differences in the magnitudes of improvement between the groups. Patients who were prescribed opioids preoperatively received 1.91-times more opioids postoperatively and had a 2.73-times longer postoperative course of treatment, according to results. Researchers noted the group prescribed opioids preoperatively had a greater proportion of women and had significantly greater rates of back pain, depression, degenerative joint disease and chronic pain conditions.
“Patients with long-term preoperative opioids demonstrated significant improvements in outcomes scores after rotator cuff repair, but they required more postoperative pain medications,” Grindel told Healio.com/Orthopedics. “Also, their preoperative function and pain scores started worse than the control group not taking opioids, and final outcomes were not as good as the non-opioid group, as well.” – by Casey Tingle
Disclosures: Funding was provided by the Medical College of Wisconsin department of orthopedic surgery. The authors report no relevant financial disclosures.
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Brent J. Morris, MD
Congratulations to Williams, Grindel and colleagues for solidifying more evidence regarding the impact of preoperative opioid use on patient-reported outcomes and opioid use after orthopedic surgery. The authors performed a retrospective, case-control study evaluating 200 patients after arthroscopic rotator cuff repair including 44 patients (22%) who were on preoperative opioids. Patients in the opioid group had significant improvements after rotator cuff repair, but they did not achieve the same peak outcomes as the non-opioid group. Furthermore, the opioid group had significantly greater postoperative opioid consumption (1.91 times) and a longer duration of postoperative opioid use (2.73 times) than the control group.
The study underscored a high prevalence of preoperative opioid use despite recent efforts to curb opioid use. Key patient variables, including preoperative opioid use, can significantly influence postoperative outcomes and can contribute to increased postoperative opioid consumption. We are reminded of the importance of informing patients about the impact of opioids and establishing reasonable expectations for both the patient and the surgeon in this difficult setting.
Co-fellowship director
Fondren Orthopedic Group, Texas Orthopedic Hospital
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