Summary
Female patients are significantly more likely to be opioid users than males prior to anterior cruciate ligament reconstruction and are more likely to continue to refill an opioid prescription in the year following surgery.
Abstract
Introduction
Anterior Cruciate Ligament (ACL) injuries represent >50% of knee injuries and often require surgery. The difference in post-operative opioid use between males and females following Anterior Cruciate Ligament reconstruction (ACLR) has yet to be investigated. The purpose of this study was to report rates of preoperative and postoperative opioid use and identify risk factors for extended opioid use following ACLR.
Methods
Patients undergoing ACLR from 2012–2018 were identified using the PearlDiver database. Opioid refill rates for males and females were compared at monthly intervals for 1 year after ACLR. Patients who had filled an opioid prescription <3 months before surgery were classified as opioid users, while those who had never filled one were classified as non-opioid users.
Results
Of 106,995 ACLR patients, 37,890 (35.4%) were opioid users <3 months before surgery and 37,554 (35.1%) had never filled an opioid prescription. Of the opioid users, 20,413 (53.9%) were female and 17,477 (46.1%) were male (p<0.001). Postoperatively, females were at higher risk of filling an opioid prescription at each monthly interval, except for the first month after surgery. The refill rate for opioid users was also higher than non-opioid users at each monthly interval after ACLR. In addition to patient sex, a preoperative diagnosis of anxiety/depression, low back pain, myalgia, a history of drug dependence, alcohol abuse, and tobacco use increased a patient’s risk of filling an opioid prescription post-operatively.
Conclusions
Females are significantly more likely to be opioid users than males prior to ACLR and are more likely to continue to refill an opioid prescription in the year following surgery. Multiple risk factors were associated with prolonged postoperative opioid utilization, including female sex, anxiety/depression, low back pain, myalgia, drug dependence, alcohol abuse, and tobacco use. These data can be used by orthopaedic surgeons to inform their prescribing practices after ACLR.