Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland.
J Knee Surg. 2023 Jan;36(1):18-28. doi: 10.1055/s-0041-1729620. Epub 2021 May 1.
Anterior cruciate ligament reconstruction (ACLR) is one of the most commonly performed outpatient orthopaedic procedures, yet there is little data about perioperative opioid prescribing practices. The purposes of this study were to quantify the perioperative opioid prescriptions filled by patients who underwent ACLR and to identify factors associated with greater postoperative opioid use. Patients who underwent ACLR at a single institution between June 2015 and May 2017 were studied using a regional prescription monitoring database to identify all preoperative and postoperative outpatient opioid prescriptions up to 2 years postoperatively. The number of morphine milligram equivalents of each opioid was calculated to determine total morphine milligram equivalents (TMEs) filled preoperatively, at discharge, and refilled postoperatively. Patients who refilled an opioid prescription postoperatively were compared with those who did not. Ninety-nine of 269 (36.8%) total patients refilled an opioid prescription postoperatively. Thirty-three patients (12.3%) required a refill after 2 weeks postoperatively, and no patients refilled after 21 months postoperatively. Fifty-seven patients (21%) received an opioid prescription in the 2 years following surgery that was unrelated to their ACL reconstruction. Increased age, higher body mass index (BMI), government insurance, current or prior tobacco use history, preoperative opioid use, and greater number of medical comorbidities were significantly associated with refilling a prescription opioid. Higher BMI and government insurance were independent predictors of refilling. Higher preoperative TMEs and surgeon were independent predictor of greater refill TMEs. In the opioid-naïve subgroup of 177 patients, only higher BMI was a predictor of refilling, and only greater comorbidities was a predictor of greater refill TMEs. The results demonstrate that preoperative opioid use was associated with postoperative opioid refills and higher refill TMEs in a dose-dependent fashion. A higher percentage of patients received an opioid prescription for reasons unrelated to the ACL reconstruction than refilled a prescription after the first 2 weeks postoperatively.
前交叉韧带重建（ACLR）是最常进行的门诊骨科手术之一，但有关围手术期阿片类药物处方的资料很少。本研究的目的是量化接受 ACLR 患者的围手术期阿片类药物处方，并确定与术后阿片类药物使用量增加相关的因素。使用区域处方监测数据库对 2015 年 6 月至 2017 年 5 月在一家机构接受 ACLR 的患者进行研究，以确定所有术前和术后门诊阿片类药物处方，直至术后 2 年。计算每个阿片类药物的吗啡毫克当量数，以确定术前、出院时和术后再次开方时的总吗啡毫克当量（TME）。比较术后开阿片类药物处方的患者与未开阿片类药物处方的患者。269 名患者中有 99 名（36.8%）患者术后再次开阿片类药物处方。33 名患者（12.3%）在术后 2 周后需要再次开处方，而在术后 21 个月后没有患者再次开处方。57 名患者（21%）在手术后 2 年内接受了与 ACL 重建无关的阿片类药物处方。年龄较大、体重指数（BMI）较高、政府保险、当前或既往吸烟史、术前阿片类药物使用和更多的合并症与开阿片类药物处方的再填充显著相关。较高的 BMI 和政府保险是再填充的独立预测因素。较高的术前 TME 和外科医生是再填充 TME 较高的独立预测因素。在 177 名阿片类药物未使用者的亚组中，只有较高的 BMI 是再填充的预测因素，只有更多的合并症是再填充 TME 较高的预测因素。结果表明，术前阿片类药物的使用与术后阿片类药物的再填充和剂量依赖性地增加再填充 TME 相关。接受 ACLR 的患者中，有较高比例的患者因与 ACL 重建无关的原因开具阿片类药物处方，而在术后前 2 周后再开处方的患者比例较高。
