HYPOTHESIS/PURPOSE: The purpose of this study is to define the impact of preoperative opioid use on post-operative opioid use, patient-reported outcomes and revision rates in a cohort of patients receiving arthroscopic shoulder surgery METHODS: Patients who underwent shoulder arthroscopy were identified from an institutional database. Inclusion criteria were completion of preoperative and postoperative patient reported outcome measures (PROMs) at one-year follow-up, in addition to a questionnaire on use of opioids and number of pills per day. Outcomes assessed included postoperative PROM scores, postoperative opioid use, persistent pain, and achievement of the patient acceptable symptomatic state (PASS). A matched-cohort analysis was performed to evaluate the impact of opioid use on achievement of postoperative outcomes while a multivariate regression was performed to determine additional risk factors. Receiver operating characteristic curves were used to establish threshold values in oral morphine equivalents (OME) that predicted each outcome.
RESULTS: A total of 184 (16.3%) were included in the opioid use (OU) group and 1058 in the N-OU group. The OU and non-opioid use (N-OU) group demonstrated statistically significant differences in both preoperative and postoperative scores across all PROMs (P<0.001). Multivariate logistic regression identified preoperative opioid use as a significant predictor of reduced achievement of PASS (OR: 0.69, 95% CI: 0.29-0.83, P = 0.008), increased likelihood to endorse persistent pain (OR: 1.73, 95% CI: 1.17-2.56 P=0.006), increased opioid use at 1-year (OR: 21.3, 95% CI: 12.2-37.2, P<0.001). Consuming a high dosage during the perioperative period increased risks of revision surgery (OR: 8.59, 95% CI: 2.12-34.78, P<0.003. Results were confirmed by the matched-cohort analysis. ROC analysis found that total OME > 1430 mg/day in the perioperative period (AUC: 0.76) or perioperative daily OME >32.5 predicted postoperative opioid consumption (AUC: 0.79).
CONCLUSIONS: Patients with a history of preoperative opioid use can achieve significant improvements in patient-reported outcomes following arthroscopic shoulder surgery. However, preoperative opioid use negatively impacts patients' level of satisfaction and is a significant predictor of pain and continued opioid usage.
LEVEL OF EVIDENCE: III, retrospective cohort study.
Keywords: Opioid narcotics risk factor rotator cuff repair shoulder arthroscopy