Older Age and Previous Opioid Use Associated With Persistent Postoperative Opioid Use

Persistent opioid use following hip arthroscopy is common, particularly among patients with a history of previous opioid use. This is according to research published in Knee Surgery, Sports Traumatology and Arthroscopy.

Using administrative datasets, researchers conducted a retrospective population-based cohort study in order to both identify the rates of persistent postoperative opioid use following hip arthroscopy and determine what factors are associated with persistent use.

The total cohort included 1909 patients (mean age, 35.8±10.5 years; 53.3% women). Within the cohort, 79.9% of patients were opioid naïve, and 20.1% had a prior history of opioid use (≥2 opioid prescriptions) within 1 year of surgery.

A comparable portion of each group filled a postoperative opioid prescription within 5 days of surgery, with no difference in average morphine equivalent or opioid drug class between groups.

A total of 11.7% of patients met the definition of persistent opioid use (2 separate opioid prescriptions filled by patients between 9 and 15 months post-hip arthroscopy). Patients with prior opioid use had a significantly higher risk compared with those who were opioid naive (odds ratio [OR], 31.95; 95% CI, 22.15-46.09). Trends were similar in the 3- to-9-month postoperative period.

The average number of filled opioid prescriptions was disproportionately higher in patients who were not opioid naive vs those who were opioid naive (17.2±44.8 vs 1.7±1.9).

Throughout the observation period, investigators did not note a change in prescribing patterns; rates of persistent opioid usage between groups were comparable, with no statistically significant differences over time.

Results of a regression analysis showed that a prior history of opioid use had the greatest association with persistent postoperative opioid use (OR, 23.79; 95% CI, 17.06-33.17). Chronic opioid use decreased from 20.1% preoperatively to 9.5% postoperatively, representing a reduction of more than 50%.

Both adjusted and subgroup regression analyses showed that older age had a continued association with persistent opioid use.

Study limitations include those associated with using an administrative database source, an inability to measure the amount of opioids consumed from each filled prescription, a lack of available patient-reported outcome measures, and small differences in baseline patient demographics.

“Following hip arthroscopy, persistent opioid use is common,” the researchers concluded. “New persistent use was identified in 2.7% of opioid-naive patients, compared with continued use in 47.4% of non-naive patients. Preoperative opioid use and older age were associated with the great[est] risk of persistent postoperative opioid use.”

Reference

Degen RM, McClure JA, Le B, Welk B, Marsh J. Persistent post-operative opioid use following hip arthroscopy is common and is associated with pre-operative opioid use and age. Knee Surg Sports Traumatol Arthrosc. Published online March 1, 2021. doi:10.1007/s00167-021-06511-0