2025 ISAKOS Biennial Congress ePoster
Impact of Preoperative Opioid Use on Two-Year Outcomes after Hip Arthroscopy
Sourabh Vellala, BS, Baltimore, MD UNITED STATES
Kathleen Healey, MD, Baltimore, MD UNITED STATES
Michael Alan McCurdy, MD, Baltimore, Maryland UNITED STATES
Dominic J. Ventimiglia, MD, Baltimore, MD UNITED STATES
Matthew T. Chrencik, MD, Baltimore, MD UNITED STATES
R Frank Henn, MD, Baltimore, MD UNITED STATES
Sean J. Meredith, MD, Baltimore, Maryland UNITED STATES
University of Maryland School of Medicine, Baltimore, MD, UNITED STATES
FDA Status Not Applicable
Summary
Our study found preoperative opioid use was a predictor of worse Musculoskeletal Outcomes Data Evaluation and Management System (MODEMS) Met Expectations at 2-year follow-up and less improvement in Numeric Pain Scale (NPS) operative site.
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Abstract
Introduction
The excessive prescription and misuse of opioids for managing pain continues to be a pervasive public health challenge in the United States. Though recent legislative steps show commitment to curbing the opioid epidemic, opioids still play a prevalent role in pain management of surgical patients. Within orthopaedics, preoperative opioid use has been consistently shown to negatively impact patient-reported outcomes (PROs). Though this has been studied in a variety of orthopaedic procedures, little exists on the impact of preoperative opioid use on two-year PROs, specifically Patient-Reported Outcome Measurement Information System (PROMIS) metrics, after hip arthroscopy. Therefore, the aim of our study was to investigate the impact of preoperative opioid use on two-year PROMIS domains.
Methods
After obtaining Institutional Review Board (IRB) approval, prospectively enrolled patients undergoing hip arthroscopy from October 2015 to February 2022 in an orthopaedic registry were retrospectively identified. Patients that completed their 2-year PRO surveys and had complete Prescription Drug Monitoring Program (PDMP) data were included for analysis. Surveys included six computer adaptive testing (CAT) PROMIS domains, Musculoskeletal Outcomes Data Evaluation and Management System (MODEMS) expectations, Numeric Pain Scale (NPS), Marx Activity Rating Scale (MARS) and Tegner Activity Scale (TAS). Opioid prescriptions were collected via review of the PDMP and classified as preoperative, discharge, and postoperative by date filled. Preoperative opioid use was defined as filling an opioid prescription within 3 months of surgery preoperatively. Bivariate analysis was performed to identify associations between patient characteristics, surgical details, PROs and preoperative opioid use. Multivariable regression analysis was conducted to identify which 2-year PROs had preoperative opioid use as a predictor.
Results
84 patients met inclusion criteria for the study. 11 (13%) had filled an opioid prescription within 3 months of their surgery. Patients with preoperative opioid use were older (p = .007), had a higher body mass index (BMI) (p = .015), and had higher American Society of Anesthesiologists (ASA) scores (p = .039). At two-year follow-up, preoperative opioid use was associated with worse PROMIS Fatigue (p = .010), TAS (p = .028), and MARS (p = .047). Multivariable regression of 2-year PROs found that preoperative opioid use was an independent predictor of worse MODEMS Met Expectations (p = .005), and less improvement in NPS operative site (p = .032) at two years postoperatively.
Conclusion
Our study found that preoperative opioid use was associated with worse two-year PROMIS F, TAS, and MARS after hip arthroscopy. When controlling for confounding, preoperative opioid use was a predictor of worse MODEMS Met Expectations at 2-year follow-up and less improvement in NPS operative site. These findings suggest that preoperative opioid use may negatively impact PROs at two years postoperatively. Future research is needed to corroborate these findings in prospective studies and to investigate if decreasing preoperative opioids improves postoperative PROs.