Recent preoperative opioid prescription is associated with increased complications after microsurgical breast reconstruction.

Prescription opioid use increases resource utilization following ventral hernia repair

Chronic preoperative opioid use is a risk factor for increased complications, resource use, and costs after cervical fusion

The impact of preoperative opioid use on outcomes after arthroscopic rotator cuff repair

P59. Chronic preoperative opioid use is associated with higher perioperative resource utilization and adverse outcomes in adult spinal deformity patients

Perioperative Opioid Analgesics and Hip Arthroscopy: Trends, Risk Factors for Prolonged Use, and Complications

The synergistic effect of preoperative opioid use and many associated preoperative predictors of poor outcome in the trauma patient population

Long-term opioid medication profile of European adult spinal deformity patients: minimum five years follow-up study

The objectives of this study are to assess perioperative opioid use in patients undergoing knee surgery and to examine the relationship between preoperative opioid use and 2-year postoperative patient-reported outcomes (PROs). We hypothesized that preoperative opioid use and, more specifically, higher quantities of preoperative opioid use would be associated with worse PROs in knee surgery patients. We studied 192 patients undergoing knee surgery at a single urban institution. Patients completed multiple PRO measures preoperatively and 2-year postoperatively, including six patient-reported outcomes measurement information system (PROMIS) domains; the International Knee Documentation Committee (IKDC) questionnaire, numeric pain scale (NPS) scores for the operative knee and the rest of the body, Marx's knee activity rating scale, Tegner's activity scale, International Physical Activity Questionnaire, as well as measures of met expectations, overall improvement, and overall satisfaction. Total morphine equivalents (TMEs) were calculated from a regional prescription monitoring program. Eighty patients (41.7%) filled an opioid prescription preoperatively, and refill TMEs were significantly higher in this subpopulation. Opioid use was associated with unemployment, government insurance, smoking, depression, history of prior surgery, higher body mass index, greater comorbidities, and lower treatment expectations. Preoperative opioid use was associated with significantly worse 2-year scores on most PROs, including PROMIS physical function, pain interference, fatigue, social satisfaction, IKDC, NPS for the knee and rest of the body, and Marx's and Tegner's scales. There was a significant dose-dependent association between greater preoperative TMEs and worse scores for PROMIS physical function, pain interference, fatigue, social satisfaction, NPS body, and Marx's and Tegner's scales. Multivariable analysis confirmed that any preoperative opioid use, but not quantity of TMEs, was an independent predictor of worse 2-year scores for function, activity, and knee pain. Preoperative opioid use and TMEs were neither independent predictors of met expectations, satisfaction, patient-perceived improvement, nor improvement on any PROs. Our findings demonstrate that preoperative opioid use is associated with clinically relevant worse patient-reported knee function and pain after knee surgery.

Retrospective cohort study. The purpose of this study is to determine the incidence of and risk factors for emergency department (ED) utilization following elective spine surgery and to quantify health care utilization in this subpopulation of patients. The Centers for Medicare and Medicaid Services (CMS) imposes financial penalties for unplanned 30-day hospital readmissions following the surgery. Determining predictive factors of hospital readmission and further health care utilization is a concern aligned with the values of both payers and providers to better improve patient outcomes. A total of 618 patients who underwent elective spine surgery between 2013 and 2018 at a single academic institution were identified. Demographic and surgical variables were compared between patients with and without 90-day ED visits. After propensity score matching, univariate analysis and binary logistic regression were used to identify risk factors for 90-day ED visits and compare health care utilization between groups. Of the 618 included patients, 44 (7.1%) had a 90-day ED visit. Patients with ED visits were more likely to have class II obesity (P=0.043), diabetes (P=0.013), congestive heart failure (P=0.006), and a history of myocardial infarction (P=0.027). Independent risk factors were obesity, diabetes, congestive heart failure, history of myocardial infarction, and preoperative opioid use. Patients with a 90-day ED visit had increased health care utilization within 1 year postoperatively, including: more MRI studies (P=0.044), repeat ED visits (P=0.033), more urgent care visits (P=0.007), and opioid prescriptions (P=0.043). While only ∼7% of patients visit the ED within 90 days of spine surgery, various patient-specific factors were predictive of this. As these patients are more likely to be high health care utilizers, attention should be garnered toward preoperative patient optimization.

Retrospective cohort study. The aim of this study was to evaluate the association between preoperative opioid use and postoperative health care utilization following elective lumbar spine surgery, and to characterize differences in surgical indications and procedures between opioid-naive (ON) and opioid-experienced (OE) patients. The U.S. opioid crisis continues to cause thousands of deaths yearly. Despite fewer prescriptions nationally, opioids remain common for pain control in spine surgery, where over half of the patients use them preoperatively. Adults who underwent elective lumbar decompression with or without fusion between 2013 and 2018 at a single academic center were retrospectively reviewed. Patients were classified as OE if they had at least one opioid prescription within 60 days preoperatively. Demographics, surgical details, and postoperative health care utilization within 1 year, which included imaging, urgent care visits, physical therapy, pain referrals, and neuromodulator prescriptions, were compared between the OE and ON groups. Unadjusted and adjusted multivariable regression and sensitivity analyses were conducted to assess independent associations. Among 433 patients, 70.5% were OE and 29.5% were ON. On unadjusted analysis, OE patients had significantly higher rates of neuromodulator prescriptions at 180 days (P<.0001) and total imaging studies at 1 year (P=.0014). After multivariable adjustment, preoperative opioid use remained independently associated with increased neuromodulator prescriptions at 180 days (β=0.23, P=.0069) and higher odds of persistent opioid use at 1 year (OR: 2.35, 95% CI: 1.15-4.83, P=.0196). No significant differences were observed in total imaging, lumbar x-ray imaging, or urgent care utilization after adjustment. Preoperative opioid use is associated with increased postoperative neuromodulator use and a higher risk of long-term opioid persistence following lumbar spine surgery. These findings highlight the need for targeted perioperative interventions to improve surgical outcomes.

This study aimed to determine the impact of preoperative opioid use on outcomes of patients undergoing ankle or hindfoot arthrodesis, or total ankle arthroplasty (TAA). We conducted a retrospective review of 190 patients undergoing an ankle or hindfoot arthrodesis (n=122) or TAA (n=68) between December 2015 and September 2020 with a single fellowship-trained orthopaedic foot and ankle surgeon at an academic medical center. Data collected included demographics, medical comorbidities, treatment history, complications and reoperation rates, patient-reported outcome measures (PROMs) (eg, Foot and Ankle Outcome Score [FAOS]), and opioid use. Patients with preoperative opioid use were more likely to continue usage at 90 (r = 0.931, P < .001) and 180 (r = 0.940, P < .001) days postoperatively. For the entire cohort, complication and reoperation rates were 48.9% and 13.2%, respectively. While preoperative opioid use groups did not differ in the overall complication rate, users had significantly more infections (user = 12.5%, nonuser = 3.3%; P = .036) and reoperations (user = 22.5%, nonuser = 10.7%; P = .049). When analyzing postoperative opioid prescriptions, there were many significant correlations with preoperative PROMs, mainly FAOS, such that increased postoperative opioid use was associated with worse subjective outcomes. Preoperative opioid users are more likely to continue postoperative opioid use, experience infections, and undergo reoperations. Level III: Retrospective cohort study.

Objective Most studies on preoperative opioid use only describe whether or not patients use opioids without characterizing reasons for use. Knowing why patients use opioids can help inform perioperative opioid management. The objective of this study was to explore pain specific reasons for preoperative opioid use prior to total hip and knee arthroplasty (THA and TKA) and their association with persistent use. Methods This is a prospective study of 197 patients undergoing THA (n = 99) or TKA (n = 98) enrolled in the Analgesic Outcomes Study between December 2015 and November 2018. All participants reported preoperative opioid use. Results Reasons for preoperative opioid use were categorized as surgical site pain only (81 [41.1%]); pain in other body areas only (22 [11.2%]); and combined pain (94 [47.7%]). Compared to patients taking opioids for surgical site pain, those with combined reasons for use had 1.24 (P = .40) and 2.28 (P = .16) greater odds of persistent use at 3 and 6 months postoperatively, adjusting for relevant covariates. Conclusions This study provides novel insights into the heterogeneity of reasons for presurgical opioid use in patients undergoing a THA or TKA. One key take away is that not all preoperative opioid use is the same and many patients are taking opioids preoperatively for more than just pain at the surgical site. Combined reasons for use was associated with long-term use, suggesting nonsurgical pain, in part, drives persistent opioid use after surgery. Future directions in perioperative care should focus on pain and non-pain reasons for presurgical opioid use to create tailored postoperative opioid weaning plans.

As the opioid epidemic escalates, preoperative opioid use has become increasingly common. Recent studies associated preoperative opioid use with postoperative morbidity. However, limited study of its impact on patients within enhanced recovery protocols (ERP) exists. We assessed the impact of preoperative opioid use on postoperative complications among colorectal surgery patients within an ERP, hypothesizing that opioid-exposed patients would be at increased risk of complications. Elective colorectal cases from August 2013 to June 2017 were reviewed in a retrospective cohort study comparing preoperative opioid-exposed patients to opioid-naïve patients. Postoperative complications were defined as a composite of complications captured by the American College of Surgeons National Surgical Quality Improvement Program. Logistic regression identified risk factors for postoperative complications. 707 patients were identified, including 232 (32.8%) opioid-exposed patients. Opioid-exposed patients were younger (57.9 vs 61.9years; p < 0.01) and more likely to smoke (27.6 vs 17.1%; p < 0.01). Laparoscopic procedures were less common among opioid-exposed patients (44.8 vs 58.1%; p < 0.01). Median morphine equivalents received were higher in opioid-exposed patients (65.0 vs 20.1mg; p < 0.01), but compliance to ERP elements was otherwise equivalent. Postoperative complications were higher among opioid-exposed patients (28.5 vs 15.0%; p < 0.01), as was median length of stay (4.0 vs 3.0days; p < 0.01). Logistic regression identified multiple patient- and procedure-related factors independently associated with postoperative complications, including preoperative opioid use (p = 0.001). Preoperative opioid use is associated with increased risk of postoperative complications in elective colorectal surgery patients within an ERP. These results highlight the negative impact of opioid use, suggesting an opportunity to further reduce the risk of surgical complications through ERP expansion to include preoperative mitigation strategies for opioid-exposed patients.

Preoperative risk factors for lower physical therapy compliance rates after shoulder arthroplasty

Postoperative opioid consumption patterns diverge between propensity matched patients undergoing traumatic and elective cervical spine fusion