Preoperative opioid users more likely to be on pain medications after ACL surgery

More than 130,000 Anterior Cruciate Ligament (ACL) surgeries take place each year with the majority of patients not requiring pain medication after three months post-operatively. However, researchers presenting their work at the American Orthopaedic Society for Sports Medicine's Annual Meeting today in Toronto, Ontario, Canada found that those patients who were filling opioid prescriptions prior to surgery were 10 times more likely to be filling prescriptions five months after surgery.

"With the ever-increasing opioid epidemic our nation is facing, understanding the risk factors for postoperative narcotic use could aid surgeons and healthcare systems in identifying patients who could benefit from a different pain management and counseling regimen than previously identified," said Chris A. Anthony, MD, lead researcher from the University of Iowa Hospitals and Clinics, in Iowa City, IA.

Anthony and his colleagues identified 4,946 arthroscopic ACLRs that were performed and documented in the Humana Inc. database between 2007-2017 using the CPT code 29888. They evaluated the effect of preoperative opioid demand on postoperative demand by comparing those who did and did not fill prescriptions pre-and post-surgery. Patients were considered preoperative opioid users if they had filled a prescription in the three months preceeding surgery. Individuals were also categorized by those who underwent only ACLR, those who underwent ACLR with meniscus repair, those who underwent ACLR with menisectomy and those with ACLR and microfracture.

According to their analysis, nearly seven percent of patients were still filling opioid prescriptions, three months following surgery with almost five percent still filling prescriptions at 12 months. Nearly 35 percent of patients (1,716/4,946) were filling opioid prescriptions in the three months prior to surgery. Those younger than 25 years were four times as likely to be filling opioid prescriptions at nine months following surgery.

"We hope that our research will help contribute additional information to the baseline opioid medication demand data and continue to increase our knowledge of how to better cope with addiction and pain management following surgery," said Anthony.