Research Article
Volume 12 Issue 12 - 2021
Opioid Prescription Trends After Arthroscopic Knee Surgery, 2009 - 2014
Joaquin Moya-Angeler1*, Carlos de la Torre3, Djibril Ba2, Guodong Liu2, William Gallagher1, Wayne J Sebastianelli1 and Dov A Bader1
1Department of Orthopedics and Rehabilitation, College of Medicine, The Pennsylvania State University, University Park, PA, USA
2Department of Public Health Sciences, PennState Hershey College of Medicine, Pennsylvania, USA
3Hospital de la Ribera, Alzira, Valencia, Spain
*Corresponding Author: Joaquin Moya-Angeler, Department of Orthopedics and Rehabilitation, College of Medicine, The Pennsylvania State University, University Park, PA, USA and Universidad de Murcia Medical School, Murcia, Spain.
Received: October 04, 2021; Published: November 26, 2021




Abstract

Background: Opioid prescription (OP) patterns among orthopaedic surgeons are often guided by multiple factors that are not well understood and can result in patients being prescribed an excessive number of opioids.

Purpose: The purpose of this study was threefold: to assess the perioperative OP trends, from 2005 to 2014, in patients undergoing five ambulatory knee procedures, to determine whether trend differences existed among procedures and to evaluate the risk factors associated with a higher OP.

Methods: Data was collected from the Market Scan® database. Search was performed using current procedural terminology codes (CPT-4) for patients with isolated anterior cruciate ligament reconstruction (IACLR), ACLR with any other intervention (ACLR+), isolated meniscectomy (IM), isolated meniscal repair (IMR) and isolated chondroplasty (IC), of age from 18 or older with and without peripheral nerve block (PNB). Patients who filled an opioid prescription in the range of four weeks before to four weeks after the intervention were included. Drugs included were Hydrocodone/Acetaminophen, Oxycodone/Acetaminophen, Tramadol and Hydromorphone/ Hydrochloride.

Results: OP trends displayed similar patterns for all opioids and procedures evaluated with no significant differences in prescription patterns among procedures (p > 0.05). Variables associated with a higher OP were the US West and South regions (p < 0.001), female sex (p < 0.001), year beyond 2004 (p < 0.001), younger age (p < 0.001) and presence of PNB (p < 0.001).

Conclusion: Over the past decade there has been an escalation in the perioperative OP trends in patients undergoing ambulatory knee surgery in the US with no significant differences in OP trends among procedures.

Keywords: Knee; Arthroscopy; Opioids; Prescription; Perioperative

References

  1. Substance Abuse and Mental Health Services Administration. 2017. Results from the 2016 National Survey on Drug Use and Health: Detailed Tables. Table 1. 28A (2016).
  2. Han B., et al. “Prescription Opioid Use, Misuse, and Use Disorders in U.S. National Survey on Drug Use and Health”. Annals of Internal Medicine5 (2015): 293-301.
  3. Leung PTM., et al. “A 1980 Letter on the Risk of Opioid Addiction”. The New England Journal of Medicine22 (2017): 2194-2195.
  4. Wunsch H., et al. “Opioids Prescribed After Low-Risk Surgical Procedures in the United States, 2004-2012”. The New England Journal of Medicine15 (2016): 1654-1657.
  5. Madras BK. “The Surge of Opioid Use, Addiction, and Overdoses: Responsibility and Response of the US Health Care System”. JAMA Psychiatry5 (2017): 441-442.
  6. Willimon SC., et al. “Opioid use in adolescents following hip and knee arthroscopy”. Orthopaedic Journal of Sports Medicine5 (2019).
  7. Wojahn RD., et al. “Opioid Consumption After Knee Arthroscopy”. The Journal of Bone and Joint Surgery American19 (2018): 1629-1636.
  8. Anthony CA., et al. “Opioid Demand Before and After Anterior Cruciate Ligament Reconstruction”. American Journal of Sports Medicine13 (2017): 3098-3103.
  9. Rozet I., et al. “Prolonged opioid use after knee arthroscopy in military veterans”. Anesthesia and Analgesia2 (2014): 454-459.
  10. Porter J and Jick H. “Addiction rare in patients treated with narcotics”. The New England Journal of Medicine2 (1980): 123.
  11. Melzack R. “The tragedy of needless pain”. Scientific American2 (1990): 27-33.
  12. Van Zee A. “The promotion and marketing of OxyContin: commercial triumph, public health tragedy”. American Journal of Public Health2 (2009): 221-227.
  13. Bloomquist ER. “The addiction potential of oxycodone (Percodan)”. California Medicine 99 (1963): 127-130.
  14. Cicero TJ., et al. “Multiple Determinants of Specific Modes of Prescription Opioid Diversion”. Journal of Drug Issues2 (2011): 283.
  15. Phillips DM. “JCAHO pain management standards are unveiled. Joint Commission on Accreditation of Healthcare Organizations”. JAMA: The Journal of the American Medical Association4 (2000): 428-429.
  16. Baker DW. “History of The Joint Commission's Pain Standards: Lessons for Today's Prescription Opioid Epidemic”. JAMA: The Journal of the American Medical Association11 (2017): 1117-1118.
  17. Statement from FDA Commissioner Scott Gottlieb on National Academies of Sciences, Engineering, and Medicine report on pain management and prescription opioid abuse (2017).
  18. Kelly S., et al. “Pressured to prescribe" The impact of economic and regulatory factors on South-Eastern ED physicians when managing he drug seeking patient”. Journal of Emergencies, Trauma, and Shock2 (2016): 58-63.
  19. Abrams GD., et al. “Trends in meniscus repair and meniscectomy in the United States, 2005-2011”. American Journal of Sports Medicine10 (2013): 2333-2339.
  20. Brophy RH., et al. “Anterior cruciate ligament reconstruction and concomitant articular cartilage injury: incidence and treatment”. Arthroscopy1 (2010): 112-120.
  21. Cullen KA., et al. “Ambulatory surgery in the United States, 2006”. National Health Statistics Reports 11 (2009): 1-25.
  22. Buller LT., et al. “Trends in anterior cruciate ligament reconstruction in the United States”. Orthopaedic Journal of Sports Medicine1 (2014): 2325967114563664.
  23. Rawal N., et al. “Survey of postoperative analgesia following ambulatory surgery”. Acta Anaesthesiologica Scandinavica8 (1997): 1017-1022.
  24. Market Scan® Commercial Claims and Encounters Database (Truven Health Analytics) (2016).
  25. Berdine HJ and Nesbit SA. “Equianalgesic Dosing of Opioids”. Journal of Pain and Palliative Care Pharmacotherapy4 (2009): 79-84.
  26. Rapp SE., et al. “Acute pain management in patients with prior opioid consumption: a case-controlled retrospective review”. Pain2 (1995): 195-201.
  27. Kao JT., et al. “A comparison of outpatient and inpatient anterior cruciate ligament reconstruction surgery”. Arthroscopy2 (1995): 151-156.
  28. Filbay SR., et al. “Health-related quality of life after anterior cruciate ligament reconstruction: a systematic review”. American Journal of Sports Medicine 5 (2014): 1247-1255.
  29. Krywulak SA., et al. “Patient satisfaction with inpatient versus outpatient reconstruction of the anterior cruciate ligament: a randomized clinical trial”. Canadian Journal of Surgery 3 (2005): 201-206.
  30. Chmielewski TL., et al. “The association of pain and fear of movement/reinjury with function during anterior cruciate ligament reconstruction rehabilitation”. Journal of Orthopaedic and Sports Physical Therapy 12 (2008): 746-753.
  31. Caldwell GL Jr and Selepec MA. “Reduced Opioid Use After Surgeon-Administered Genicular Nerve Block for Anterior Cruciate Ligament Reconstruction in Adults and Adolescents”. HSS Journal 1 (2019): 42-50.
  32. Jildeh TR., et al. “Risk Factors For Postoperative Opioid Use In Arthoscopic Meniscal Surgery”. Arthroscopy 2 (2019): 575-580.
  33. Coley KC., et al. “Retrospective evaluation of unanticipated admissions and readmissions after same day surgery and associated costs”. Journal of Clinical Anesthesia 5 (2002): 349-353.
  34. Vadivelu N., et al. “Challenges of pain control and the role of the ambulatory pain specialist in the outpatient surgery setting”. Journal of Pain Research 9 (2016): 425-435.
  35. Daniels SD., et al. “Patient Satisfaction With Nonopioid Pain. Management Following Arthroscopic Partial Meniscectomy and/or Chondroplasty”. Arthroscopy (2019): S0749-8063.
Citation: : Joaquin Moya-Angeler., et al. “Opioid Prescription Trends After Arthroscopic Knee Surgery, 2009 - 2014”. EC Orthopaedics 12.12 (2021): 14-21.

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