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Lubitz MG, Latario L, Ogbeide-Latario O, Hughes K, Clegg S, Molla V, Brown M, Busconi B, DeAngelis N. Access to an Educational Video Preoperatively Has No Effect on Postoperative Opioid Use After Arthroscopic Partial Meniscectomy of the Knee: A Prospective Cohort Study. Arthrosc Sports Med Rehabil 2024; 6:100885. [PMID: 38434603 PMCID: PMC10909595 DOI: 10.1016/j.asmr.2024.100885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 12/30/2023] [Indexed: 03/05/2024] Open
Abstract
Purpose To determine whether access to a website with an educational video would decrease postoperative opioid use in patients undergoing arthroscopic partial meniscectomy. Methods Enrolled patients who underwent arthroscopic partial meniscectomy at a single center were randomized to either the intervention or control group prior to surgery. The intervention group received a card with access to an online educational video regarding opioids with their postoperative instructions; the control group did not. The online video was just over 5 minutes long and contained general information about the dangers of opioid use, how to safely dispose of unused opioids, and local support contact information. Data were collected by telephone 10 to 14 days postoperatively and analyzed with GraphPad Prism version 9.5.0. Patient characteristics including age, sex, body mass index, allergies, smoking, depression, alcohol abuse, American Society of Anesthesiologists level, diagnosis of chronic obstructive pulmonary disease, hypertension, diabetes, substance abuse, employment status, workers' compensation, and sports participation were analyzed and correlated with postoperative opioid use. Results A total of 166 patients were included in this study, with 78 in the control group and 88 in the intervention group. Mean number of pills consumed was 3 in the control group and 2.2 in the intervention group. This difference did not reach statistical significance. Patients who were obese, smokers, or diagnosed with depression both consumed more opioids and were less likely to take no narcotics postoperatively. Patients who participated in sports consumed fewer total opioids on average than those who did not. Subgroup analysis of patients with higher risk factors did not show a difference between the control and intervention groups in the average amount of opioid used or the likelihood of using no narcotics. Among all patients, 82 (49%) used no narcotics postoperatively and 90% used 8 or fewer tablets. Conclusions Directing patients to an educational website and video is not an effective tool in decreasing opioid consumption. Patients undergoing arthroscopic meniscectomy who are obese, active smokers, and clinically depressed or do not participate in sports are likely to use more postoperative narcotics. Regardless of access to the online educational video, half of patients used no narcotics. Level of Evidence Level II, prospective cohort.
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Affiliation(s)
- Marc G. Lubitz
- Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Chan, School of Medicine, Worcester, Massachusetts, U.S.A
| | - Luke Latario
- Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Chan, School of Medicine, Worcester, Massachusetts, U.S.A
| | - Oghomwen Ogbeide-Latario
- University of Massachusetts Chan Medical Science Training Program, Worcester, Massachusetts, U.S.A
| | - Kevin Hughes
- Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Chan, School of Medicine, Worcester, Massachusetts, U.S.A
| | - Stephanie Clegg
- Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Chan, School of Medicine, Worcester, Massachusetts, U.S.A
| | - Vadim Molla
- Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Chan, School of Medicine, Worcester, Massachusetts, U.S.A
| | - Michael Brown
- Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Chan, School of Medicine, Worcester, Massachusetts, U.S.A
| | - Brian Busconi
- Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Chan, School of Medicine, Worcester, Massachusetts, U.S.A
| | - Nicola DeAngelis
- Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Chan, School of Medicine, Worcester, Massachusetts, U.S.A
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Weinerman J, Vazquez A, Schurhoff N, Shatz C, Goldenberg B, Constantinescu D, Hernandez GM. The impacts of anxiety and depression on outcomes in orthopaedic trauma surgery: a narrative review. Ann Med Surg (Lond) 2023; 85:5523-5527. [PMID: 37920654 PMCID: PMC10619579 DOI: 10.1097/ms9.0000000000001307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 09/06/2023] [Indexed: 11/04/2023] Open
Abstract
Introduction The impact of anxiety and depression on outcomes in orthopaedic trauma surgery is a topic of growing research interest. Patients and methods Orthopaedic trauma patients often experience high rates of psychiatric disorders, with anxiety and depression being the most prevalent. Mental health disorders have been shown to increase the risk of negative surgical outcomes and morbidity. This narrative review seeks to summarize the current literature surrounding the impacts of anxiety and depression on orthopaedic trauma surgery outcomes. Discussion There is a bidirectional relationship between chronic pain and mental health disorders, involving overlapping brain regions and neurotransmitter pathways. Anxiety and depression have been identified as predictors of negative surgical outcomes in orthopaedic trauma patients. Screening tools like the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder Screener-7 (GAD-7), and Medical Outcomes Study 36-item Short Form (SF-36) can assess mental health status and help tailor interventions. Psychological distress, chronic pain, and traumatic limb amputation are factors that contribute to adverse mental health outcomes in orthopaedic trauma patients. Opioid use for pain management is common in orthopaedic surgery, but it can worsen symptoms of depression and lead to dependency. Non-opioid pain management strategies may improve postoperative outcomes by reducing the impact of opioid-exacerbated depression. Conclusion Mental health interventions, both preoperative and postoperative, are crucial in optimizing surgical outcomes and improving patient quality of life. Multidisciplinary approaches that address both physical and mental health are recommended for orthopaedic trauma patients. Further research is needed to develop effective interventions for improving mental health outcomes in this patient population.
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Affiliation(s)
- Jonathan Weinerman
- Department of Education, The University of Miami Leonard M. Miller School of Medicine
| | - Arianna Vazquez
- Department of Education, The University of Miami Leonard M. Miller School of Medicine
| | - Nicolette Schurhoff
- Department of Education, The University of Miami Leonard M. Miller School of Medicine
| | - Connor Shatz
- Department of Education, The University of Miami Leonard M. Miller School of Medicine
| | - Brandon Goldenberg
- Department of Orthopaedic Surgery, University of Miami Hospital, Miami, Florida, USA
| | - David Constantinescu
- Department of Orthopaedic Surgery, University of Miami Hospital, Miami, Florida, USA
| | - Giselle M. Hernandez
- Department of Orthopaedic Surgery, University of Miami Hospital, Miami, Florida, USA
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Castle JP, Jildeh TR, Abbas MJ, Hennekes ME, Buckley PJ, Shabet CL, Cotter DL, Moutzouros V. Patient factors influencing the choice of opioid versus non-opioid postoperative analgesia following common sports procedures: a prospective survey study. J Orthop 2023; 40:1-6. [PMID: 37124142 PMCID: PMC10130914 DOI: 10.1016/j.jor.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 04/03/2023] [Accepted: 04/06/2023] [Indexed: 05/02/2023] Open
Abstract
Purpose Despite established opioid-free protocols for postoperative analgesia after common orthopaedic sports procedures, many patients continue to request opioids postoperatively. The purpose of this study was to elucidate patient factors influencing preferences for opioid versus nonopioid postoperative analgesia. Methods Patients (age >/ = 15) without a history of a documented chronic pain disorder who were scheduled for one of ten sports procedure types from August 2020 to May 2021 were eligible for inclusion. Patients were excluded if undergoing revision surgery, had concomitant injuries, had opioids use >3 months preoperatively, or unable to read English. Recruitment ended after 100 patients enrolled. At the patients' preoperative visit, patients were administered a written survey assessing pain medication preferences. Participants completed the Opioid Risk Tool survey, as well as Visual Analog Scale and Patient-Reported Outcome Measurement Information System surveys. Results One hundred patients participated in the study. Forty-two patients preferred opioids versus 58 patients preferring nonopioid postoperative analgesia. Patients preferring opiates were more likely to have had previous surgery (90.2% vs. 69.6%, p = 0.023) with post-operative pain managed with opiates (87.5% vs 55.4%, p = 0.003), higher preoperative Visual Analog Scale score (6±3.5 vs. 3±2, p < 0.001), reported post-operative pain as a reason for opioids preference (88.1% vs 20.0%, p < 0.001), and were less concerned about addiction (4.8% vs. 45.5%, p < 0.001) and side effects (11.9% vs. 52.7%, p < 0.001). For every unit increase in Visual Analog Scale score, the odds of preferring opioid pain control increased 1.41 times. Conclusions Patients with a history of prior surgery utilizing opioid pain control, higher Visual Analog Scale scores preoperatively, and concern for inadequately managed postoperative pain were more likely to prefer opioid pain control following common orthopaedic sports procedures. Patients may benefit from increased preoperative education about opioid risks and the role of multimodal pain management regimens.
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Affiliation(s)
| | - Toufic R. Jildeh
- Michigan State University College of Human Medicine, 4660 Hagadorn Rd Suite 420, East Lansing, MI, 48823, USA
| | | | | | | | - Christina L. Shabet
- University of Michigan Medical School, 1301 Catherine St, Ann Arbor, MI, 40109, USA
| | - Daniel L. Cotter
- Ascension St. John Hospital, 22101 Moross Rd, Detroit, MI, 48236, USA
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Masood R, Mandalia K, Moverman MA, Puzzitiello RN, Pagani NR, Menendez ME, Salzler MJ. Patients With Functional Somatic Syndromes-Fibromyalgia, Irritable Bowel Syndrome, Chronic Headaches, and Chronic Low Back Pain-Have Lower Outcomes and Higher Opioid Usage and Cost After Shoulder and Elbow Surgery. Arthroscopy 2022; 39:1529-1538. [PMID: 36592697 DOI: 10.1016/j.arthro.2022.12.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 12/06/2022] [Accepted: 12/15/2022] [Indexed: 12/31/2022]
Abstract
PURPOSE To perform a systematic review assessing the relationship between functional somatic syndromes (FSSs) and patient-reported outcome measures (PROMs), postoperative opioid consumption, and hospitalization costs after shoulder and elbow surgery. METHODS A systematic review of the PubMed and Web of Science databases was conducted according to Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines to identify all studies evaluating the effect of having at least 1 FSS (fibromyalgia, irritable bowel syndrome, chronic headaches, chronic low back pain) on outcomes after shoulder and elbow surgeries. Outcomes of interest included postoperative analgesic use, PROMs, and hospitalization costs. RESULTS The review identified a total of 320 studies, of which 8 studies met the inclusion criteria. The total number of participants in our 8 included studies was 57,389. Three studies (n = 620) reported PROMs. These studies demonstrated that the presence of at least 1 FSS is predictive of significantly greater pain scores and lower quality of recovery, Disability Arm Shoulder and Hand, American Shoulder and Elbow Surgeons Shoulder Score, and Single Assessment Numeric Evaluation scores postoperatively. Although scores were inferior in among patients with FSS, 2 of the 3 studies showed improvement in PROMs in this group of patients. Seven studies (n = 56,909) reported postoperative opioid use. Of these, 5 reported that a diagnosis of at least 1 FSS was a strong risk factor for long-term opioid use after surgery. One study (n = 480) found that time-driven activity-based costs were significantly greater in patients with FSSs. CONCLUSIONS Patients with functional somatic syndromes have less-favorable PROMs postoperatively, consume more opioids postoperatively, and have greater health care costs after elective shoulder and elbow procedures. Although PROMs among patients with FSSs are inferior compared with those without FSSs, PROMs still improved compared with baseline. LEVEL OF EVIDENCE Level III, systematic review of Level II-III studies.
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Affiliation(s)
- Raisa Masood
- Department of Orthopaedic Surgery, Tufts Medical Center, Boston, Massachusetts, U.S.A
| | - Krishna Mandalia
- Tufts University School of Medicine, Boston, Boston, Massachusetts, U.S.A
| | - Michael A Moverman
- Department of Orthopaedic Surgery, Tufts Medical Center, Boston, Massachusetts, U.S.A
| | - Richard N Puzzitiello
- Department of Orthopaedic Surgery, Tufts Medical Center, Boston, Massachusetts, U.S.A
| | - Nicholas R Pagani
- Department of Orthopaedic Surgery, Tufts Medical Center, Boston, Massachusetts, U.S.A
| | - Mariano E Menendez
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Matthew J Salzler
- Department of Orthopaedic Surgery, Tufts Medical Center, Boston, Massachusetts, U.S.A.
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Machine Learning Model Identifies Preoperative Opioid Use, Male Sex, and Elevated BMI as Predictive Factors for of Prolonged Opioid Consumption Following Arthroscopic Meniscal Surgery. Arthroscopy 2022; 39:1505-1511. [PMID: 36586470 DOI: 10.1016/j.arthro.2022.12.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 12/03/2022] [Accepted: 12/13/2022] [Indexed: 12/31/2022]
Abstract
PURPOSE To develop a predictive machine learning model to identify prognostic factors for continued opioid prescriptions after arthroscopic meniscus surgery. METHODS Patients undergoing arthroscopic meniscal surgery, such as meniscus debridement, repair, or revision at a single institution from 2013 to 2017 were retrospectively followed up to 1 year postoperatively. Procedural details were recorded, including concomitant procedures, primary versus revision, and whether a partial debridement or a repair was performed. Intraoperative arthritis severity was measured using the Outerbridge Classification. The number of opioid prescriptions in each month was recorded. Primary analysis used was the multivariate Cox-Regression model. We then created a naïve Bayesian model, a machine learning classifier that uses Bayes' theorem with an assumption of independence between variables. RESULTS A total of 581 patients were reviewed. Postoperative opioid refills occurred in 98 patients (16.9%). Multivariate logistic modeling was used; independent risk factors for opioid refills included male sex, larger body mass index, and chronic preoperative opioid use, while meniscus resection demonstrated decreased likelihood of refills. Concomitant procedures, revision procedures, and presence of arthritis graded by the Outerbridge classification were not significant predictors of postoperative opioid refills. The naïve Bayesian model for extended postoperative opioid use demonstrated good fit with our cohort with an area under the curve of 0.79, sensitivity of 94.5%, positive predictive value (PPV) of 83%, and a detection rate of 78.2%. The two most important features in the model were preoperative opioid use and male sex. CONCLUSION After arthroscopic meniscus surgery, preoperative opioid consumption and male sex were the most significant predictors for sustained opioid use beyond 1 month postoperatively. Intraoperative arthritis was not an independent risk factor for continued refills. A machine learning algorithm performed with high accuracy, although with a high false positive rate, to function as a screening tool to identify patients filling additional narcotic prescriptions after surgery. LEVEL OF EVIDENCE III, retrospective comparative study.
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Predictive factors for requiring secondary opioid prescriptions following outpatient plastic and reconstructive surgery. Plast Reconstr Surg 2022; 150:716e-717e. [PMID: 35839482 DOI: 10.1097/prs.0000000000009422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lu Y, Forlenza E, Wilbur RR, Lavoie-Gagne O, Fu MC, Yanke AB, Cole BJ, Verma N, Forsythe B. Machine-learning model successfully predicts patients at risk for prolonged postoperative opioid use following elective knee arthroscopy. Knee Surg Sports Traumatol Arthrosc 2022; 30:762-772. [PMID: 33420807 DOI: 10.1007/s00167-020-06421-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 12/14/2020] [Indexed: 12/30/2022]
Abstract
PURPOSE Recovery following elective knee arthroscopy can be compromised by prolonged postoperative opioid utilization, yet an effective and validated risk calculator for this outcome remains elusive. The purpose of this study is to develop and validate a machine-learning algorithm that can reliably and effectively predict prolonged opioid consumption in patients following elective knee arthroscopy. METHODS A retrospective review of an institutional outcome database was performed at a tertiary academic medical centre to identify adult patients who underwent knee arthroscopy between 2016 and 2018. Extended postoperative opioid consumption was defined as opioid consumption at least 150 days following surgery. Five machine-learning algorithms were assessed for the ability to predict this outcome. Performances of the algorithms were assessed through discrimination, calibration, and decision curve analysis. RESULTS Overall, of the 381 patients included, 60 (20.3%) demonstrated sustained postoperative opioid consumption. The factors determined for prediction of prolonged postoperative opioid prescriptions were reduced preoperative scores on the following patient-reported outcomes: the IKDC, KOOS ADL, VR12 MCS, KOOS pain, and KOOS Sport and Activities. The ensemble model achieved the best performance based on discrimination (AUC = 0.74), calibration, and decision curve analysis. This model was integrated into a web-based open-access application able to provide both predictions and explanations. CONCLUSION Following appropriate external validation, the algorithm developed presently could augment timely identification of patients who are at risk of extended opioid use. Reduced scores on preoperative patient-reported outcomes, symptom duration and perioperative oral morphine equivalents were identified as novel predictors of prolonged postoperative opioid use. The predictive model can be easily deployed in the clinical setting to identify at risk patients thus allowing providers to optimize modifiable risk factors and appropriately counsel patients preoperatively. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Yining Lu
- Department of Orthopaedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Enrico Forlenza
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Ryan R Wilbur
- Department of Orthopaedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Ophelie Lavoie-Gagne
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Michael C Fu
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Adam B Yanke
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Brian J Cole
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Nikhil Verma
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Brian Forsythe
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
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Castle JP, Jildeh TR, Buckley PJ, Abbas MJ, Mumuni S, Okoroha KR. Older, Heavier, Arthritic, Psychiatrically Disordered, and Opioid-Familiar Patients Are at Risk for Opioid Use After Medial Patellofemoral Ligament Reconstruction. Arthrosc Sports Med Rehabil 2021; 3:e2025-e2031. [PMID: 34977662 PMCID: PMC8689254 DOI: 10.1016/j.asmr.2021.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 10/06/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose To investigate which factors predispose patients for prolonged opioid use after medial patellofemoral ligament (MPFL) reconstruction. Methods A retrospective review of all patients who underwent MPFL reconstruction at a single institution between January 2013 and June 2020 was conducted. Opioid consumption before and after surgery was recorded and confirmed using Michigan Automated Prescriptions System monitoring program. Patients were classified into preoperative opioid users and nonusers. Risk factors for continued opioid use were assessed by collecting patient demographic variables, psychiatric history, number of previous patellar dislocations, and operative factors. Results A total of 102 patients were included during the time frame of interest. Patients were on average 21.6 ± 8.5 years old with a mean body mass index of 28.2 ± 7.9. Thirty patients (29.0%) sustained >10 dislocations preoperatively. Preoperative opioid use was present in 13 (12.7%) patients. Greater than 10 dislocations (odds ratio [OR] 5.00, 95% confidence interval [CI] 1.12-20.92) and psychiatric history (OR 3.33, 95% CI, 1.2-9.1; P = .016) significantly predicted opioid refills the first month after surgery. Risk factors for opioid refills at 2 to 12 months postoperatively included smoking (OR 4.50, 95% CI 1.13-17.96), preoperative opioid use (OR 7.32, 95% CI 1.88-28.47), psychiatric disorder (OR 3.77, 95% CI 2.3-6.2; P < .001), age >30 years (OR 7.03, 95% CI 3.63-13.61; P < .001), and obesity (OR 2.68, 95% CI 1.40-5.14; P = .002). Compared with Outerbridge 0, a greater percentage of patients with Outerbridge 1 or 2 and 3 or 4 continued using opioids 2 to 12 months after surgery (OR 3.06, 95% CI 1.33-7.02; P = .006 and OR 2.86, 95% CI 1.24-6.59; P = .010, respectively). Conclusions For patients undergoing MPFL reconstruction, preoperative opioid use, cartilage damage, age >30 years, smoking history, body mass index >30, and history of psychiatric disorder were found to be significantly associated with prolonged opioid use after surgery. Postoperative opioid refills in this cohort declined after 1 month. Level of Evidence Level III, retrospective cohort study.
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Affiliation(s)
- Joshua P. Castle
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, U.S.A
- Address correspondence to Joshua P. Castle, M.D., Department of Orthopaedic Surgery, Henry Ford Hospital, 2799 W. Grand Blvd., Detroit, MI 48202.
| | - Toufic R. Jildeh
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, U.S.A
| | - Patrick J. Buckley
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, U.S.A
| | - Muhammad J. Abbas
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, U.S.A
| | - Salma Mumuni
- Wayne State University School of Medicine, Detroit, Michigan, U.S.A
| | - Kelechi R. Okoroha
- Department of Orthopedic Surgery, Mayo Clinic, Minneapolis, Minnesota, U.S.A
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Chaturvedi R, Tram J, Chakravarthy K. Reducing opioid usage in total knee arthroplasty postoperative pain management: a literature review and future directions. Pain Manag 2021; 12:105-116. [PMID: 34551582 DOI: 10.2217/pmt-2020-0107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Total knee arthroplasty (TKA) is a common orthopedic surgery performed with a projected 3.5 million procedures to be done by 2030. Current postoperative pain management for TKA is insufficient, as it results in extensive opioid consumption and functional decline postoperatively. This study identifies the best practices for postoperative TKA pain management through a literature review of the last three years. Studies utilizing interventional techniques (local infiltration analgesia, nerve blocks) and pharmacologic options were reviewed on PubMed, Embase, Ovid Medline and Scopus. Primary outcomes analyzed were the effect of different analgesic approaches on pain reduction, opioid use reduction and improvements in functional mobility or quadriceps strength postoperatively. Additionally, this paper explores the use of cooled radiofrequency ablation, a minimally invasive therapy, for preoperative and postoperative TKA pain management.
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Affiliation(s)
- Rahul Chaturvedi
- Department of Anesthesiology, Division of Pain Medicine, University of California San Diego, 9400 Campus Point Dr, La Jolla, CA 92037, USA
| | - Jennifer Tram
- Department of Anesthesiology, Division of Pain Medicine, University of California San Diego, 9400 Campus Point Dr, La Jolla, CA 92037, USA
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D'Onghia M, Ciaffi J, McVeigh JG, Di Martino A, Faldini C, Ablin JN, Meliconi R, Ursini F. Fibromyalgia syndrome - a risk factor for poor outcomes following orthopaedic surgery: A systematic review. Semin Arthritis Rheum 2021; 51:793-803. [PMID: 34153893 DOI: 10.1016/j.semarthrit.2021.05.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 04/20/2021] [Accepted: 05/31/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Fibromyalgia (FM) is a complex syndrome incorporating many features associated with poor outcome in orthopaedic surgery. Aim of the present review was to comprehensively characterize the available evidence on the consequences of pre-existent FM on the outcomes of orthopaedic surgery. METHODS We performed a systematic search in MedLine and Web of Science (WOS) to identify studies evaluating the effect of FM on patient-centred outcomes, opioids consumption and postoperative complications. RESULTS The search strategy identified 519 records in PubMed and 507 in WOS. A total of 27 articles were deemed eligible for inclusion in qualitative synthesis. Based on quality assessment, 10 studies were rated as good quality, 10 as fair quality and 7 as poor quality. Studies reporting the prevalence of FM in consecutive patients undergoing orthopaedic surgery (n = 19) were included in quantitative synthesis. The pooled prevalence of FM in patients undergoing orthopaedic surgery was 4.1% (95% CI: 2.4-6.8) in those receiving hip or knee surgery, 10.1% (95% CI: 5.7-17.2) in those receiving shoulder or elbow surgery and 21.0% (95% CI: 18.5-23.7) in those receiving spinal surgery. The results of our systematic review consistently report FM as a significant risk factor for less satisfaction, higher pain, worse functional outcome, increased risk for postoperative opioids prescription and higher rate of medical and surgical complications following orthopaedic surgery. CONCLUSION Identifying pre-existing FM in patients scheduled for elective orthopaedic surgery may help to better assess the benefit/risk ratio, improve patients' awareness and minimize any discrepancy between expectancy and results.
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Affiliation(s)
- Martina D'Onghia
- Medicine & Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Jacopo Ciaffi
- Medicine & Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Joseph G McVeigh
- School of Clinical Therapies, Discipline of Physiotherapy, College of Medicine and Health, University College Cork, Ireland
| | - Alberto Di Martino
- 1st Orthopaedic and Traumatology Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy; Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Cesare Faldini
- 1st Orthopaedic and Traumatology Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy; Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Jacob N Ablin
- Internal Medicine H, Tel Aviv Sourasky Medical Center & Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Riccardo Meliconi
- Medicine & Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy; Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Francesco Ursini
- Medicine & Rheumatology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy; Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum University of Bologna, Bologna, Italy.
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Rossi MJ. Editorial Commentary: Opioid Sparing Through Patient Education Programs Is the Future for Sports Medicine and Arthroscopic Surgery to Optimize Outcome. Arthroscopy 2021; 37:1573-1576. [PMID: 33896509 DOI: 10.1016/j.arthro.2021.02.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 02/21/2021] [Accepted: 02/22/2021] [Indexed: 02/02/2023]
Abstract
Opioid research in sports medicine and arthroscopic surgery has exploded in the last few years. The literature definitively shows that preoperative opioid usage-in so-called opioid exposed, tolerant, and familiar patients-increases postoperative usage, readmission rates, and medical complications, yielding poorer outcome. Strategies to combat the deleterious effects of preoperative opioid use should be used to include ownership and acknowledgment of the problem, adherence to opioid prescribing protocols, and use of a multimodal anesthesia program that can mitigate the adverse effects by limiting abuse and preventing potential poor outcome. Adding patient education programs to change patient modifiable risk factors shows promise while simultaneously optimizing appropriate patient expectations that are linked to increased outcome. Thus, opioid mitigation, sparing, or altogether avoidance through improved education programs and opioid prescribing protocols will likely be the future of sports medicine and arthroscopic surgery to optimize patient outcome.
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12
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Baron JE, Khazi ZM, Duchman KR, Wolf BR, Westermann RW. Increased Prevalence and Associated Costs of Psychiatric Comorbidities in Patients Undergoing Sports Medicine Operative Procedures. Arthroscopy 2021; 37:686-693.e1. [PMID: 33239183 DOI: 10.1016/j.arthro.2020.10.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 10/15/2020] [Accepted: 10/16/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the prevalence of preoperatively diagnosed psychiatric comorbidities and the impact of these comorbidities on the healthcare costs of ten common orthopaedic sports medicine procedures. METHODS Patients undergoing 10 common sports medicine procedures from 2007 to 2017q1 were identified using the Humana claims database. These procedures included anterior cruciate ligament reconstruction; posterior cruciate ligament reconstruction; medial collateral ligament repair/reconstruction; Achilles repair/reconstruction; Rotator cuff repair; meniscectomy/meniscus repair; hip arthroscopy; arthroscopic shoulder labral repair; patellofemoral instability procedures; and shoulder instability repair. Patients were stratified by preoperative diagnoses of depression, anxiety, bipolar disorder, or schizophrenia. Cohorts included patients with ≥1 psychiatric comorbidity (psychiatric) versus those without psychiatric comorbidities (no psychiatric). Differences in costs across groups were compared using Mann-Whitney U tests, with significance defined as P < .05. Linear regression analysis was used to assess rates of procedures per year from 2006 to 2016. RESULTS In total, 226,402 patients (57.7% male) from 2007 to 2017q1 were assessed. The prevalence of ≥1 psychiatric comorbidity within the entire database was 10.31% (reference) versus 21.21% in those patients undergoing the 10 investigated procedures. Patients with psychiatric comorbidity most frequently underwent rotator cuff repair (28%), hip labral repair (26.3%) and meniscectomy/meniscus repair (25.0%%) had ≥1 psychiatric comorbidity. Compared with the no psychiatric cohort, diagnosis of ≥1 psychiatric comorbidity was associated with increased health care costs for all 10 sports medicine procedures ($9678.81 vs $6436.20, P < .0001). CONCLUSIONS The prevalence of preoperatively diagnosed psychiatric comorbidities among patients undergoing orthopaedic sports medicine procedures is high. The presence of psychiatric comorbidities preoperatively was associated with increased postoperative costs following all investigated orthopaedic sports medicine procedures. LEVEL OF EVIDENCE Level III; retrospective comparative study.
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Affiliation(s)
| | - Zain M Khazi
- University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
| | - Kyle R Duchman
- University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
| | - Brian R Wolf
- University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
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Jildeh TR. Editorial Commentary: Postoperative Analgesia After Arthroscopy: A Step Toward the Personalization of Pain Control. Arthroscopy 2020; 36:2486-2487. [PMID: 32891249 DOI: 10.1016/j.arthro.2020.06.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 06/09/2020] [Indexed: 02/02/2023]
Abstract
Identification of risk factors for prolonged opioid use is imperative as opioid misuse continues to plague society. Recent data suggest that many modifiable and nonmodifiable patient factors may be associated with prolonged opioid use after arthroscopic meniscal surgery. Surgeons and patients share the burden of the opioid epidemic and must collaborate to decrease the overall opioid burden on society. As the number of tools to treat pain and the knowledge of at-risk patients grow, standardized postoperative narcotic regimens to treat a diverse population of patients are no longer acceptable; narcotic regimens must be customized to each patient. To limit opioid use and enhance patient outcomes, it is apparent that the next frontier of postoperative pain control is upon us: the personalization of pain control.
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