Abstract
Objectives:
While several studies have noted that patients are routinely over-prescribed opioids, few have reported usage following arthroscopic surgery. Nearly 2 million arthroscopic procedures are performed annually, and one study estimates that opioids are prescribed in excess in 88% of patients recovering from arthroscopic knee surgery. Such surplus of postoperative opioid prescription creates a conundrum, as many patients do not appropriately dispose of unused opioid pills, and the majority of recreational opioid users obtain these medications from friends or family. The objectives of this study were to determine opioid consumption, utilization of total prescription, and allocation for unused opioids following five common arthroscopic surgeries.
Methods:
This study is a prospective trial enrolling patients between the ages of 15-40 who were scheduled to undergo elective anterior cruciate ligament (ACL) reconstruction, labral repair of the hip or shoulder, meniscectomy, or meniscal repair. Patients were prescribed either 5-325 hydrocodone-acetaminophen or 5-325 oxycodone-acetaminophen based on surgeon preference. Patients completed a daily opioid usage survey during the 2-week postoperative period. In addition, patients completed a survey on postoperative day 21 inquiring about continued opioid use and medication disposal, if applicable. Opioid medication consumption was converted to morphine milliequivalents (MME) where one 5 mg oxycodone pill is equivalent to 7.5 MME and one 5 mg hydrocodone pill is equivalent to 5.0 MME. T-tests or Mann-Whitney U tests were used to calculate differences between continuous data. Chi-Square or Fisher’s Exact were used for categorical data.
Results:
Of the 200 patients enrolled in the study, 100 (50%) underwent ACL reconstruction, 26 (13%) underwent arthroscopic hip labral repair, 37 (19%) underwent arthroscopic shoulder labral repair, 23 (12%) underwent meniscectomy, and 14 (7%) underwent meniscal repair. The mean MME consumption in the 14 days following each procedure was calculated: ACL reconstruction (88.9), hip arthroscopy (84.8), shoulder arthroscopy (55.5), meniscectomy (24.3), and meniscal repair (31.2). This corresponded to a utilization rate of 40.4%, 36.5%, 40.7%, 37.4%, and 34.6% respectively (Table 1). Mean MME consumption was greatest on postoperative day 1 in all procedures, and only 6.6% of patients reported continued opioid use in the third postoperative week. Of the 141 patients available for follow up at 3 weeks, 113 reported having opioid medication remaining. Of the patients with remaining medication, 25.6% intended to keep their medication for future use (Figure 2).
Conclusions:
The results of our study indicate that patients who undergo the aforementioned arthroscopic procedures consume a mean of 70 MME in the 2-week postoperative period, translating into an average of 9-14 pills consumed, depending on medication prescribed. Few patients reported requiring opioid medication after 2 weeks postoperatively. Patients undergoing ACL reconstruction and hip labral repairs consumed the highest MME, followed by shoulder labral repair patients who consumed approximately 3 times more opioids than primary meniscal procedures. Approximately 65% of total opioids prescribed went unused, and over one fourth of patients intended to keep their remaining medication for future usage.
