Risk Factors for Increased Consumption of Narcotics After Hip Arthroscopy

A Prospective, Randomized Control Trial

Ryan S. Selley, MD; Matthew J. Hartwell, MD; Bejan A. Alvandi, MD; Michael A. Terry, MD; Vehniah K. Tjong, MD

Disclosures

J Am Acad Orthop Surg. 2021;29(12):527-536. 

In This Article

Results

A total of 100 patients were included for final analysis, 53 patients in the 30-tablet group and 47 patients in the 60-tablet group. The average patient age in the entire cohort was 37.7 ± 11.3 years, the average body mass index was 27.2 ± 6.0 kg/m2, and the majority (65/100, 65%) were female. A large percentage (79/100, 79%) were actively employed. No patients were using narcotics at the time of enrollment, but 16% (16/100) had used them within a year before surgery, 12% (12/100) were using benzodiazepines, and 4% (4/100) of patients were using muscle relaxants within a year of surgery. All patients underwent isolated acetabuloplasty for bony FAI decompression, 95% (95/100) underwent labral repair, 3% (3/100) labral débridement, and 2% (2/100) labral reconstruction. In addition, 30% (30/100) of patients underwent iliotibial band windowing and bursectomy, 10% (10/100) underwent iliopsoas tendon lengthening, 1% (1/100) required a microfracture, and 1% (1/100) received an intra-articular platelet-rich plasma injection. No significant differences were found in preoperative age, sex, body mass index, smoking status, employment status, preoperative narcotic use, family history of narcotic use, iHOT-12, Pain Catastrophizing Scale scores, or procedures performed. Both combined and group demographic data are reported in Table 1 and Table 2.

No significant differences were found between groups in the number of tablets consumed at 24 hours, 48 hours, or final follow-up (Table 3). Patients in the 30-tablet group required an average of 9.2 ± 11.1 (92 MME) opioid tablets compared with the 60-tablet group, which required 10.5 ± 14.0 (105 MME), P = 0.60. Significantly more unused opioids were found in the 60-tablet group compared with the 30-tablet group (49.5 ± 14.0 versus 22.0 ± 8.8, P < 0.001). No significant difference was found in pain scores between groups at 24 hours, 48 hours, or final follow-up (Table 3).

Several risk factors for increased postoperative opioid use were identified. Of five covariates selected on univariate analysis (Table 4), multivariate analysis identified three significant predictors of increased opioid use, specifically preoperative opioid and muscle relaxant use and iHOT-12 scores. Preoperative opioid and muscle relaxant use independently significantly increased the average number of tablets used postoperatively by 12.6 and 22.5, respectively, compared with patients not using either medication. Furthermore, preoperative iHOT-12 scoring independently predicted postoperative opioid use; for each one-point decrease in the iHOT-12, the number of tablets used postoperatively increased by 0.25 (Table 5).

Combining both cohorts and analyzing all patients as a whole, this study found that 80% of patients used 14 tablets or less, and 94% of patients required less than 30 tablets (Figure 3). Two patients in the 30-tablet cohort requested a prescription refill, and 3 patients in the 60-tablet cohort required more than 30 tablets. A total of 12 patients did not require any postoperative narcotics once discharged from postoperative recovery. No identifiable differences were found in patient characteristics or preoperative variables that significantly varied in these patients from the rest of the cohort. In total, for this study, 4,470 narcotic tablets were prescribed, and 3,490 or 78% went unused.

Figure 3.

Total opioid pill utilization grouped by number of pills taken.

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