Summary

Our study found that preoperative morphine milligram equivalents (MMEs) and current smoking status were independent predictors of opioid refill within 3 months postoperatively after hip arthroscopy.

Abstract

Introduction

The opioid crisis continues to be one of the most difficult and lethal public health challenges that the United States (U.S.) has faced in the last few decades. Recent implementation of opioid prescription cap laws and establishment of Prescription Drug Monitoring Programs (PDMPs) are just two examples of legislative efforts to combat this crisis and reduce the overall prescription of opioids. This crisis is particularly relevant to orthopaedic surgeons, as they are some of the highest prescribers of opioids among surgical subspecialties in the U.S. Orthopaedic patients also have some of the highest rates of preoperative opioid use, which has consistently shown to be a predictor of persistent opioid use after surgery. Hip arthroscopy as a minimally invasive surgical option for femoroacetabular impingement (FAI) and labral tears has also increased recently, showing substantial improvement in various patient-reported outcomes (PROs) for these patients. Though previous studies have investigated pain management factors that influence short-term opioid use after hip arthroscopy, there are few patient factors identified, including baseline PROs, that predict opioid refills after hip arthroscopy. Therefore, the aim of this study was to identify predictors of opioid refill after hip arthroscopy.

Methods

After Institutional Review Board (IRB) approval, patients that underwent hip arthroscopy for FAI and/or labral tears from November 2015 to June 2022 at a single institution were identified from a prospectively enrolled orthopaedic registry. Patients that had complete PDMP data from one year preoperatively to two years postoperatively were included for this study. Patients completed PRO surveys at baseline and 2-year follow-up that included Patient-Reported Outcomes Measurement Information System (PROMIS), Musculoskeletal Outcomes Data Evaluation and Management System (MODEMS) expectations, Numeric Pain Scale (NPS), Marx Activity Rating Scale (MARS) and Tegner Activity Scale (TAS). Refills were categorized as an opioid prescription filled within 3 months of filling a discharge opioid prescription. Prescriptions were converted to morphine milligram equivalents (MMEs) for comparison. Bivariate analysis was performed to find associations between patient factors and opioid refills. Multivariable regression analysis was performed to identify predictors of opioid refill after hip arthroscopy.

Results

126 patients were included for this study, with 20 (15.9%) patients refilling an opioid prescription within 3 months postoperatively. Opioid refills were associated with current smoking status (p = .001) and annual income <$70,000 (p = .002). Refills were also associated with greater preoperative MME (p < .001), discharge MME (< .001), total postoperative MME (p < .001), baseline PROMIS Fatigue (F, p = .027), and baseline MARS (p = .007). On multivariable regression, preoperative MME (p = .006) and current smoking status (p = .004) were independent predictors of 3-month refill after hip arthroscopy.

Conclusion

Our study found that preoperative MME and current smoking status were independent predictors of opioid refill within 3 months postoperatively after hip arthroscopy. Identifying modifiable risk factors for refilling an opioid prescription after surgery may allow for targeted intervention prior to surgery. Further research with larger, prospective cohorts are necessary to determine if interventions can impact postoperative opioid refills.