Researchers from Virginia have published a new study using the PearlDiver Technologies database to assess patients who underwent knee arthroscopy from 2007 to 2015.
Study: Trends in Opioid Use and Knee Arthroplasty
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#kneearthroplasty#opioidSecondary
Their work, “Narcotics and Knee Arthroscopy: Trends in Use and Factors Associated with Prolonged Use and Postoperative Complications,” appears in the June 2018 edition of Arthroscopy.
Brian C. Werner, M.D., an assistant professor of orthopedic surgery at the University of Virginia Health System, commented to OTW, “Opioid use and abuse has become a big challenge for all physicians. As orthopaedic surgeons are the third largest prescriber of opioids, we felt it important to examine perioperative opioid use for one of our most common surgeries, knee arthroscopy.”
The authors wrote, “The most significant predictor for prolonged postoperative use was preoperative use, with the odds increasing as the number of preoperative prescriptions increased. Preoperative narcotic use was associated with increased emergency department visits, hospital admission, and infection. Prolonged postoperative narcotic use was associated with subsequent ipsilateral knee arthroscopy as well as subsequent knee arthroplasty.”
Dr. Werner told OTW, “The most important results of this study were the identification of a very high rate of preoperative and prolonged postoperative narcotic use in patients undergoing knee arthroscopy, and a significant association between them. Furthermore, preoperative and prolonged postoperative narcotic use were significantly associated with increased odds for postoperative complications after knee arthroscopy.”
“Orthopaedic surgeons should identify patients who are at a high risk for prolonged postoperative narcotic use and work with the them to reduce any modifiable risk factors. Also, surgeons must understand how important the issue of opioid use is and limit prescribing to only the amount absolutely necessary.”
“Orthopaedic surgeons should be careful in counseling patients about their risks of postoperative narcotic use. We should continue to look for ways to limit narcotic use in our patients to what is only absolutely necessary.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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