Summary

Pre-operative opioid use predicted increased postoperative use at 2 and 6 weeks following ACL reconstruction surgery, with pre-operative opioid use correlated with lower PROs at all time points compared to those who did not use opioids before surgery, yet not all of these met MCID.

Abstract

Objective

The excess prescription and use of opioid pain medication has become a recent focus in the literature and legislature. We aim to investigate whether pre-operative opioid use has an adverse effect on outcomes after ACL reconstruction.

Methods

Patients enrolled in our institution’s prospective ACL registry between 4/2012 and 1/2016 completed KOOS and WOMAC outcome scores pre-operatively and at 6 months and 2 years post operatively. Patients who underwent subsequent procedures or revision surgery were excluded, n= 45. Charts were reviewed to identify patients who had documented pre-operative opioid use and opioid use at two weeks and 6 weeks post-op. Univariate analysis was carried out to identify statistically significant changes as well as minimal clinically important differences (MCID) in outcome scores.

Results

The incidence of pre-operative opioid use in our cohort was 14.2% (N = 22). The percentage of patients using opioids was higher in patients who were using opioid pre-operatively at both 2 weeks (50% vs. 32.3%, p = 0.14) and 6 weeks (18.1% vs. 5.26%, p = 0.06) post-operatively. Outcome scores were higher for all scales and at all time points for patients who were not using opioid pre-operatively, however these did not reach MCID. There was no significant difference in the amount of change in outcome scores at these time points between the pre-operative users and non-users.

Conclusion

We found that 14.2% of our patients undergoing ACL reconstruction used opioids prior to surgery. Preoperative opioid use predicted increased postoperative use at 2 and 6 weeks following surgery. Patients who had pre-operative opioid use had lower PROs at all time points compared those who did not use opioids before surgery, yet not all of these data points met MCID. Preoperative opioid use may not only predict prolonged postoperative use but may have deleterious effects on outcomes after surgery.