Preoperative opioid use may be linked with inferior outcomes after rotator cuff repair
Key takeaways:
- Preoperative opioid use may be a significant predictor of inferior pain and functional outcomes up to 6 months after rotator cuff repair.
- Outcomes were compared with a cohort of opioid-naïve patients.
According to published results, patients with a history of preoperative opioid use had inferior outcomes for pain and function in the early postoperative period after arthroscopic rotator cuff repair compared with opioid-naïve patients.
“Our study demonstrates the importance of setting appropriate postoperative expectations for at-risk patient populations before surgery. A variety of risk factors can influence postoperative outcomes, such as preoperative opioid use, and it is important to counsel patients on these risk factors,” Justin J. Greiner, MD, from the department of orthopedic surgery and rehabilitation at the University of Nebraska Medical Center, told Healio. “In the setting of preoperative opioid use, patients can expect to have noticeable improvements in pain and function following rotator cuff repair. However, it is important to consider that patients using opioids preoperatively have a lower chance of achieving an acceptable symptom state postoperatively compared with those without a history of preoperative opioid use.”
Greiner and colleagues performed a retrospective cohort comparison of data from 760 consecutive patients (mean age, 60 years) who underwent arthroscopic rotator cuff repair between 2018 and 2020. Among the cohort, 280 patients (37%) received a prescription for opioids within 1 year before surgery, while 480 patients (63%) had no history of opioid prescriptions.
According to the study, patients were assessed preoperatively and at 3- and 6-month follow-ups. Outcomes included VAS pain scores, shoulder subjective value (SSV) scores and American Shoulder and Elbow Surgeons Shoulder scores. Greiner and colleagues also assessed the percentages of patients who achieved the minimal clinically important difference (MCID), substantial clinical benefit (SCB) and patient-acceptable symptoms state (PASS) for patient-reported outcomes (PROs).
Overall, Greiner and colleagues found patients with a history of preoperative opioid use had statistically worse preoperative and postoperative PROs.
At 6-month follow-up, the opioid-naïve cohort had a greater percentage of patients who achieved the PASS for VAS pain score (58.7% vs. 40.2%), ASES score (39.9% vs. 26.7%) and SSV score (55.5% vs. 45.5%) compared with patients with a history of preoperative opioid use. However, Greiner and colleagues found no significant differences between the cohorts in percentages of patients who achieved the MCID or SCB for any PRO at 3- and 6-month follow-ups.
After multivariate regression analysis, Greiner and colleagues found preoperative opioid use was a significant predictor of higher VAS pain scores (beta coefficient = 1.07; 95% CI, 0.81-1.33), lower ASES scores (beta coefficient = –7.47; 95% CI, –5.2 to –9.7) and lower SSV scores (beta coefficient = –7.21; 95% CI, –9.61 to –4.8).
“The results of the current study highlight the need for continued study of patients that have risk factors for inferior outcomes after surgery,” Greiner said. “Alternative or supplemental techniques that can be employed in the preoperative, perioperative and postoperative setting with the goal of optimizing patient outcomes deserve further investigation.”
Perspective
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This was an interesting article as it contributes significantly to the growing body of literature supporting inferior outcomes following orthopedic surgery in patients with preoperative opioid use. Although the authors acknowledge certain limitations, such as limited follow-up, this article reinforces the vital need for providers to limit preoperative opioid prescriptions whenever possible.
Unfortunately, many patients present with a history of multiple opioid prescriptions prior to their initial presentation. In such cases, surgeons can educate their patients about the possibility of achieving somewhat inferior outcomes, at least in the short term. It is important to note, however, that both groups in the study showed statistically significant improvements in patient-reported outcomes, so surgical intervention can still be considered for both groups. Expectations should be tempered for patients who are opioid tolerant, but it is reassuring to patients and surgeons that they also show improvement.
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