Risk Factors for Opioid Use After Patellofemoral Stabilization Surgery: A Population-Based Study of 1,316 Cases.

Background: Orthopaedic surgeons remain the third-highest group of opioid prescribers among physicians in the United States, accounting for 8% of all opioid prescriptions. The purpose of this study was to identify risk factors for opioid consumption and opioid prescription refills after patellofemoral stabilization surgery. We hypothesized that preoperative opioid use and younger age would be independent risk factors for postoperative opioid use.

Methods: Patients undergoing primary patellar stabilization surgery between 2007-2017 in the Humana Inc. administrative claims database were identified using Current Procedural Terminology (CPT) codes for patellofemoral stabilization procedures (CPT-27420, 27422, 27427,27418). Patients were categorized into opioid naive (N-OU) and those who filled opioid prescriptions within 3 months prior to surgery (OU). Patients in the OU cohort were further categorized into those who filled prescriptions at 1-3 months before surgery (C-OU) and those who filled opioid prescriptions only in the month preceding surgery (A-OU). Descriptive statistics and multivariate analyses were performed to identify risk factors for postoperative opioid use at 3 and 12 months using the open-source R software (www.r-project.org) housed within PearlDiver.

Results: A total of 1,316 eligible patients were included. One year postoperatively, there was a greater risk of opioid consumption in the OU cohort (OU vs N-OU: 22.2% vs 4.1%; Relative Risk [RR]: 1.233; 95% CI: 1.172- 1.298; P< 0.0001). C-OU (OR: 5.74; 95% CI: 3.75- 8.9; P< 0.0001), obesity (OR: 1.76; 95% CI: 1.14- 2.69; P = 0.0099), and preoperative diagnosis of depression or anxiety (OR: 1.83; 95% CI: 1.01- 3.25; P = 0.0435) were independent risk factors for opioid use at 12 months postoperatively. Younger age (age <30) was associated witha lower risk of opioid use at 3 months (OR: 0.3, 95% CI: 0.21- 0.44; P< 0.0001) and 12 months (OR: 0.29; 95% CI: 0.17- 0.46; P< 0.0001) postoperatively.

Conclusions: Preoperative opioid utilization significantly increased opioid prescription filling following patellofemoral stabilization surgery. Patient-specific variables including obesity and preoperatively diagnosed depression or anxiety also increased the risk of postoperative opioid utilization. Given the relatively young age and high activity level of patients undergoing patellofemoral stabilization surgery, heightened awareness of patient-specific factors must be considered when selecting appropriate pain management regimens postoperatively.Level of Evidence: III.