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Persistent post-operative opioid use following hip arthroscopy is common and is associated with pre-operative opioid use and age

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Hip arthroscopy utilization continues to increase worldwide. Post-operative pain management is essential to allow appropriate rehabilitation. While multimodal analgesic protocols have been described, consensus agreement is lacking and opioid analgesia remains a mainstay of treatment. Unfortunately, the risk of persistent opioid use among opioid-naïve and non-naïve patients following hip arthroscopy remains unclear. Therefore, the purpose of this study was to identify rates of persistent post-operative opioid use, as well as to identify factors associated with persistent use.

Methods

A retrospective cohort study was conducted using linked administrative data from Ontario, Canada. Participants were adults who underwent hip arthroscopy between 2013 and 2018. Patients < 18 or > 60 years of age as well as those who had undergone prior hip arthroscopy were excluded. The primary exposure was whether patients had filled ≥ 2 opioid prescriptions within 1 year prior to their hip arthroscopy to define the opioid naïve and non-naïve populations. The primary outcome was persistent opioid use, defined as 2 + prescriptions filled between 9 and 15 months post-op. A regression analysis was performed to identify factors associated with persistent opioid usage.

Results

Of the 1909 patients, 1525 (79.9%) were opioid-naïve, while 384 (20.1%) had a prior history of opioid use within 1 year of surgery. 224 patients (11.7%) demonstrated persistent opioid use, with ≥ 2 prescriptions filled between 9 and 15 months post-op. Of those, 42 (18.8%) cases were among opioid-naïve patients, while the remaining 182 (81.2%) were among non-naïve patients. The risk of persistent post-operative use was significantly higher in those with prior opioid use (OR 31.95, 95% CI 22.15–46.09; p < 0.0001). Regression analysis confirmed that pre-operative opioid use (OR 23.79, 95% CI 17.06–33.17; p < 0.0001) and older age (OR 1.04, 95% CI 1.02–1.05, p < 0.0001) were associated with increased risk of persistent post-operative opioid use.

Conclusion

Following hip arthroscopy, persistent opioid use is common. New persistent use was identified in 2.7% of opioid-naïve patients, compared with continued use in 47.4% of non-naïve patients. Pre-operative opioid use and older age were associated with the greater risk of persistent post-operative opioid use.

Level of evidence

Level III.

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Acknowledgements

This study was supported by the ICES Western site. ICES is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). Core funding for ICES Western is provided by the Academic Medical Organization of Southwestern Ontario (AMOSO), the Schulich School of Medicine and Dentistry (SSMD), Western University, and the Lawson Health Research Institute (LHRI). The opinions, results and conclusions reported in this paper are those of the authors and are independent from the funding sources. No endorsement by ICES, AMOSO, SSMD, LHRI, or the Ontario MOHLTC is intended or should be inferred. Parts of this material are based on data and/or information compiled and provided by CIHI. However, the analyses, conclusions, opinions and statements expressed in the material are those of the author(s), and not necessarily those of CIHI.

Funding

A Catalyst grant, obtained via the Bone and Joint Institute at Western University (R5788A05), supported the research analyst’s costs for this study.

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Authors and Affiliations

  1. Department of Surgery, Western University, London, ON, Canada

    Ryan M. Degen, J. Andrew McClure, Blayne Welk & Jacquelyn Marsh

  2. Fowler Kennedy Sport Medicine Clinic, Western University, London, ON, N6A 3K7, Canada

    Ryan M. Degen

  3. Bone and Joint Institute, Western University, London, ON, Canada

    Ryan M. Degen & Jacquelyn Marsh

  4. Institute for Clinical and Evaluative Sciences (ICES) Western, London, ON, Canada

    Britney Le

  5. School of Physical Therapy, Faculty of Health Sciences, Western University, London, ON, Canada

    Jacquelyn Marsh

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  1. Ryan M. Degen
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  2. J. Andrew McClure
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  3. Britney Le
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  4. Blayne Welk
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  5. Jacquelyn Marsh
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Contributions

RD, JAM, BL and JM—study design, data collection, analysis, literature review and manuscript preparation. BW—data review/risk clearance and manuscript editing.

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Correspondence to Ryan M. Degen.

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Degen, R.M., McClure, J.A., Le, B. et al. 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 29, 2437–2445 (2021). https://doi.org/10.1007/s00167-021-06511-0

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