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Prescription Patterns and Risk Factors for Prolonged Opioid Dependence in Elective Anterior Cruciate Ligament Reconstruction in a Military Population.
Orthop J Sports Med. 2020 Jun; 8(6):2325967120926489.OJ

Abstract

Background

Limited data are available regarding excessive opioid prescribing in the perioperative period after routine orthopaedic procedures in US military personnel.

Purpose

To examine the demographic profile of the patients receiving these medications and to identify potential risk factors for prolonged opioid use after anterior cruciate ligament reconstruction (ACLR) in the active duty military population.

Study Design

Case-control study; Level of evidence, 3.

Methods

The Military Analysis and Reporting Tool (M2) was used to search the Military Health System Data Repository (MDR) for patients undergoing ACLR from 2012 through 2015 and specifically for active duty personnel with an arthroscopically assisted ACLR (Current Procedural Terminology [CPT] code 29888). Complete opioid prescription filling history was also obtained. This study had 2 primary outcomes: (1) use of opiate analgesics more than 90 days after surgery, representing prolonged opiate prescriptions, and (2) high levels of postoperative opiate use, defined as having filled prescriptions accounting for greater than the 95th percentile of morphine equivalents for patients in the study cohort. Data were analyzed via multivariate regression analysis to identify potential associations with the primary outcomes.

Results

A total of 9474 patients met the inclusion criteria. Median patient age was 27 years, and the sample included 1316 (14%) female and 8158 (86%) male patients. A total of 66 (0.7%) patients had a preoperative diagnosis for substance abuse; 2656 (28%) patients continued to receive opioid prescriptions more than 90 days after surgery, and 502 (5%) patients were in the top 95th percentile of all opioid users within the study cohort. Total preoperative morphine equivalents per day and total perioperative morphine equivalents per day were highly important risk factors for both outcomes, although other demographic factors such as race, sex, and age may play minor roles.

Conclusion

We identified total preoperative morphine equivalents, total perioperative morphine equivalents, sex, and race as potential predictors of prolonged opioid use after ACLR. This information may prove useful in developing a predictive model to identify at-risk patients before surgery. This could help mitigate future misuse or abuse and improve preoperative patient counseling regarding pain management expectations.

Authors+Show Affiliations

Department of Surgery Division of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, Maryland, USA. Uniformed Services University, Bethesda, Maryland, USA.Naval Medical Center Portsmouth, Portsmouth, Virginia, USA.Department of Surgery Division of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, Maryland, USA.Department of Surgery Division of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, Maryland, USA. Uniformed Services University, Bethesda, Maryland, USA.Department of Surgery Division of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, Maryland, USA. Uniformed Services University, Bethesda, Maryland, USA. Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, Maryland, USA.Department of Surgery Division of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, Maryland, USA. Uniformed Services University, Bethesda, Maryland, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32647731

Citation

Anderson, Ashley B., et al. "Prescription Patterns and Risk Factors for Prolonged Opioid Dependence in Elective Anterior Cruciate Ligament Reconstruction in a Military Population." Orthopaedic Journal of Sports Medicine, vol. 8, no. 6, 2020, p. 2325967120926489.
Anderson AB, Balazs GC, Brooks DI, et al. Prescription Patterns and Risk Factors for Prolonged Opioid Dependence in Elective Anterior Cruciate Ligament Reconstruction in a Military Population. Orthop J Sports Med. 2020;8(6):2325967120926489.
Anderson, A. B., Balazs, G. C., Brooks, D. I., Potter, B. K., Forsberg, J. A., & Dickens, J. F. (2020). Prescription Patterns and Risk Factors for Prolonged Opioid Dependence in Elective Anterior Cruciate Ligament Reconstruction in a Military Population. Orthopaedic Journal of Sports Medicine, 8(6), 2325967120926489. https://doi.org/10.1177/2325967120926489
Anderson AB, et al. Prescription Patterns and Risk Factors for Prolonged Opioid Dependence in Elective Anterior Cruciate Ligament Reconstruction in a Military Population. Orthop J Sports Med. 2020;8(6):2325967120926489. PubMed PMID: 32647731.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prescription Patterns and Risk Factors for Prolonged Opioid Dependence in Elective Anterior Cruciate Ligament Reconstruction in a Military Population. AU - Anderson,Ashley B, AU - Balazs,George C, AU - Brooks,Daniel I, AU - Potter,Benjamin K, AU - Forsberg,Jonathan A, AU - Dickens,Jonathan F, Y1 - 2020/06/29/ PY - 2020/7/11/entrez PY - 2020/7/11/pubmed PY - 2020/7/11/medline KW - ACL reconstruction KW - big data KW - opioid epidemic KW - opioid use disorders KW - opioids KW - perioperative risk management SP - 2325967120926489 EP - 2325967120926489 JF - Orthopaedic journal of sports medicine JO - Orthop J Sports Med VL - 8 IS - 6 N2 - Background: Limited data are available regarding excessive opioid prescribing in the perioperative period after routine orthopaedic procedures in US military personnel. Purpose: To examine the demographic profile of the patients receiving these medications and to identify potential risk factors for prolonged opioid use after anterior cruciate ligament reconstruction (ACLR) in the active duty military population. Study Design: Case-control study; Level of evidence, 3. Methods: The Military Analysis and Reporting Tool (M2) was used to search the Military Health System Data Repository (MDR) for patients undergoing ACLR from 2012 through 2015 and specifically for active duty personnel with an arthroscopically assisted ACLR (Current Procedural Terminology [CPT] code 29888). Complete opioid prescription filling history was also obtained. This study had 2 primary outcomes: (1) use of opiate analgesics more than 90 days after surgery, representing prolonged opiate prescriptions, and (2) high levels of postoperative opiate use, defined as having filled prescriptions accounting for greater than the 95th percentile of morphine equivalents for patients in the study cohort. Data were analyzed via multivariate regression analysis to identify potential associations with the primary outcomes. Results: A total of 9474 patients met the inclusion criteria. Median patient age was 27 years, and the sample included 1316 (14%) female and 8158 (86%) male patients. A total of 66 (0.7%) patients had a preoperative diagnosis for substance abuse; 2656 (28%) patients continued to receive opioid prescriptions more than 90 days after surgery, and 502 (5%) patients were in the top 95th percentile of all opioid users within the study cohort. Total preoperative morphine equivalents per day and total perioperative morphine equivalents per day were highly important risk factors for both outcomes, although other demographic factors such as race, sex, and age may play minor roles. Conclusion: We identified total preoperative morphine equivalents, total perioperative morphine equivalents, sex, and race as potential predictors of prolonged opioid use after ACLR. This information may prove useful in developing a predictive model to identify at-risk patients before surgery. This could help mitigate future misuse or abuse and improve preoperative patient counseling regarding pain management expectations. SN - 2325-9671 UR - https://www.unboundmedicine.com/medline/citation/32647731/Prescription_Patterns_and_Risk_Factors_for_Prolonged_Opioid_Dependence_in_Elective_Anterior_Cruciate_Ligament_Reconstruction_in_a_Military_Population DB - PRIME DP - Unbound Medicine ER -
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