2017 ISAKOS Biennial Congress ePoster #2217
Does Patient Education Prior to Arthroscopic Rotator Cuff Repair Decrease Narcotic Consumption? A Randomized Prospective Study
Michael G. Ciccotti, MD, Philadelphia, PA UNITED STATES
Usman Syed, BS, Philadelphia, PA UNITED STATES
Alexander W. Aleem, MD, Philadelphia, PA UNITED STATES
Charles Wowkanech, BS, Egg Harbor Township, NJ UNITED STATES
Charles L. Getz, MD, Philadephia, PA UNITED STATES
Matthew Pepe, MD, Egg Harbor Township, NJ UNITED STATES
Fotios P. Tjoumakaris, MD, Egg Harbor Township, NJ UNITED STATES
Bradford Tucker, MD, Philadelphia, PA UNITED STATES
Joseph A. Abboud, MD, Philadelphia, PA UNITED STATES
Luke Austin, MD, Egg Harbor Township, NJ UNITED STATES
Rothman Institute, Philadelphia, PA, UNITED STATES
FDA Status Not Applicable
In order to help combat the problem of opioid addiction, we sought to determine, through a randomized prospective study design, if patient education on proper use of narcotic medication would decrease narcotic consumption in the post-operative period after arthroscopic rotator cuff repair (ARCR).
Opioids are commonly prescribed medications after orthopaedic injuries and surgery to decrease subjective pain complaints. Opioid addiction has become an increasingly common problem in the United States and, often times, a prescription can be a gateway to a patient becoming chronically addicted to opioid medication. Opioid addiction is on the rise in the United States and there is increasing concern among physicians that overuse may lead to abuse. In order to help combat this problem, we sought to determine, through a randomized prospective study design, if patient education on proper use of narcotic medication would decrease narcotic consumption in the post-operative period after arthroscopic rotator cuff repair (ARCR).
Patients undergoing primary ARCR at our institution were prospectively enrolled in a randomized fashion to receive either formal education on proper use of narcotics versus no education. The education group received instruction on the proper use of opioids, dosage, side effects, dependence, and addiction while the control group received education regarding the surgery alone. The education program consisted of a 2-minute narrated video in addition to a handout. All the subjects were blind to the randomization and true purpose of the study. Variables such as age, sex, and body mass index (BMI) were recorded. To determine risk of opioid abuse of the patient, the physician completed a validated Opioid Risk Tool (ORT). Patients were given the same post-operative medication regimen. Patients filled out questionnaires at their 2- and 6- week follow up querying VAS pain score, refills, and total number of narcotic pills remaining. Standard statistical comparison was performed with t test calculations.
67 patients completed 6-week follow-up with 34 patients in the control group and 33 patients in the study group. There were no statistically significant differences in age, sex, BMI, ORT score, preoperative and postoperatively VAS score between the groups. The average VAS pain scores pre-operatively were 5.29 and 6.61 for the study group (SG) and control group (CG), respectively. Post-operatively the VAS scores were 2.53 (SG) and 3.17 (CG). The average opioid risk tool scores were 1.75 (SG) and 1.32 (CG). Patients who received pre-operative education on average consumed 26 pills compared to 35 in the control group. More than 20 pills were consumed by only 48% of the study group compared to 76% in the control group (p = 0.01).
Patient education is associated with a significant decrease in the number of patients consuming more than 20 narcotic pills in the acute post-operative period. Although the difference in average amount of narcotics consumed was not statistically significant, the increased frequency of patients in the control group that consumed a high number of narcotics was, suggesting benefit in preoperative education on narcotics. This is the first study to document that preoperative education can help reduce the number of patients consuming high levels of post-operative narcotics. Future recruitment and study analysis will help determine if this effect is long-lasting and can help reduce the incidence of drug dependence and addiction among this patient population.