Preoperative Opioid Use is Associated with Worse Preoperative Patient Reported Outcomes in Hip Arthroscopy Patients

Michael S Rocca; Evan L Honig; Andrew Tran; Matthew P Kolevar; Samir Kaveeshwar; Ali Aneizi; Natalie L Leong; Jonathan D Packer; R Frank Henn 3rd; Sean J Meredith

doi:10.1016/j.jisako.2024.04.016

Preoperative Opioid Use is Associated with Worse Preoperative Patient Reported Outcomes in Hip Arthroscopy Patients

J ISAKOS. 2024 Apr 29:S2059-7754(24)00086-5. doi: 10.1016/j.jisako.2024.04.016. Online ahead of print.

Authors

Affiliations

¹ Department of Orthopaedics, University of Maryland School of Medicine, 2200 Kernan Drive, Baltimore, Maryland, USA, 21207. Electronic address: michael.rocca@som.umaryland.edu.
² Department of Orthopaedics, University of Maryland School of Medicine, 2200 Kernan Drive, Baltimore, Maryland, USA, 21207. Electronic address: ehonig@som.umaryland.edu.
³ Department of Orthopaedics, University of Maryland School of Medicine, 2200 Kernan Drive, Baltimore, Maryland, USA, 21207. Electronic address: atran@som.umaryland.edu.
⁴ Department of Orthopaedics, University of Maryland School of Medicine, 2200 Kernan Drive, Baltimore, Maryland, USA, 21207. Electronic address: mkolevar@som.umaryland.edu.
⁵ Department of Orthopaedics, University of Maryland School of Medicine, 2200 Kernan Drive, Baltimore, Maryland, USA, 21207. Electronic address: samir.kaveeshwar@som.umaryland.edu.
⁶ Department of Orthopaedics, University of Maryland School of Medicine, 2200 Kernan Drive, Baltimore, Maryland, USA, 21207. Electronic address: ali.aneizi@som.umaryland.edu.
⁷ Department of Orthopaedics, University of Maryland School of Medicine, 2200 Kernan Drive, Baltimore, Maryland, USA, 21207. Electronic address: nleong@som.umaryland.edu.
⁸ Department of Orthopaedics, University of Maryland School of Medicine, 2200 Kernan Drive, Baltimore, Maryland, USA, 21207. Electronic address: jpacker@som.umaryland.edu.
⁹ Department of Orthopaedics, University of Maryland School of Medicine, 2200 Kernan Drive, Baltimore, Maryland, USA, 21207. Electronic address: fhenn@som.umaryland.edu.
¹⁰ Department of Orthopaedics, University of Maryland School of Medicine, 2200 Kernan Drive, Baltimore, Maryland, USA, 21207. Electronic address: smeredith@som.umaryland.edu.

PMID: 38692433
DOI: 10.1016/j.jisako.2024.04.016

Abstract

Objectives: The purpose of this study was to define the rate of preoperative opioid use among patients undergoing hip arthroscopy, ascertain which clinical factors are associated with opioid use, and assess the effect of preoperative opioid usage on preoperative patient-reported outcome (PRO) measures.

Methods: A single institution orthopaedic registry was retrospectively analyzed for patients undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAI) with or without labral tear between 2015 and 2022. Patients completed Patient-Reported Outcomes Measurement Information System (PROMIS) in six domains, Numeric Pain Scores (NPS), and Musculoskeletal Outcomes Data Evaluation and Management System expectations domain preoperatively. Patients' charts were reviewed to determine demographic factors and identify any active opioid prescription within 6 weeks before surgery. Bivariate analysis was used to determine associations between preoperative opioid use and baseline PROs. Statistically significant bivariate associations were further tested by multivariate analysis to determine independent predictors.

Results: A total of 123 patients were included (age 39.7 ± 12.0 years; 87 females; body mass index 27.4 ± 5.7 kg/m²). There were 21 patients (17%) using opioids preoperatively. Prior orthopaedic or other surgery and lower education level was associated with preoperative opioid use. Patients with preoperative opioid use scored statistically significantly worse compared to those without preoperative opioid use on baseline PROMIS Physical Function (38.6 vs 40.5, p = 0.01), Pain Interference (65.9 vs 60.2, p = 0.001), Fatigue (60.7 vs 51.6, p = 0.005), Social Satisfaction (38.2 vs 43.2, p = 0.007), and Depression (54.2 vs 48.8, p = 0.01). Preoperative opioid use was also associated with statistically significantly worse pre-operative NPS for both the operative hip (6.3 vs 4.6, p = 0.003) and whole body (3.0 vs 1.4, p = 0.008). Preoperative opioid use was an independent predictor of worse baseline PROMIS Pain Interference, Fatigue, Social Satisfaction, and NPS for the operative hip.

Conclusion: Patients using opioids preoperatively had worse baseline PROs for physical function, pain, social satisfaction, and depression than those not using opioids preoperatively. When controlling for confounding variables, preoperative opioid use was independently predictive of worse baseline pain, fatigue, and social satisfaction.

Level of evidence: Level III, prognostic study.

Keywords: Hip Arthroscopy; Opioids; PROMIS; Patient-Reported Outcome Measures.