PROGNOSTIC FACTORS FOR INCREASED PAIN AND OPIOID CONSUMPTION FOLLOWING ARTHROSCOPIC KNEE AND SHOULDER SURGERY IN THE ACUTE POSTOPERATIVE PERIOD

Various opioid-sparing strategies have demonstrated promising results following knee and shoulder arthroscopy. There is limited high-quality evidence exists shedding light on risk factors associated with increased post-operative opioid consumption and inferior pain outcomes following knee and shoulder arthroscopy, hence the purpose of this analysis. Using the dataset from the Non-Opioid Prescriptions after Arthroscopic Surgery in Canada (NO PAin) trial, eight prognostic factors were chosen a priori to evaluate their effect on opioid consumption and patient-reported pain following arthroscopic knee and shoulder surgery. These included age, sex, body mass index (BMI), tobacco use, alcohol use, number of comorbidities, employment status, and operative time. The primary analysis for this study was a multivariable linear regression using the number of OMEs consumed at 2- and 6-weeks postoperatively as the dependant variable. Secondary analyses included a multivariable linear regression with VAS pain scores at 2- and 6-weeks postoperatively as the dependant variable. Analyses of variance (ANOVAs) were conducted on categorical dependant variables found to be significant predictors of the model to assess whether statistically significant differences existed across these dependant variables’ categories. All tests were two-tailed with alpha = 0.05. A total of 193 patients were included in the final analysis. Included patients were primarily male (62.5%), with a mean age of 43.0 (SD, 15.3) years and a mean BMI of 29.2. Most patients underwent knee surgery (n=143; 73.1%). The most common procedures performed was a meniscectomy (n=93; 48.2%) in the knee and biceps tenotomy (n=25; 13.0%) in the shoulder. Tobacco usage was significantly associated with higher opioid usage at 2-weeks (p < 0 .001) and 6-weeks (p=0.02) postoperatively. Previous tobacco users had a higher 2-week (p=0.002) and cumulative OME (p=0.002) consumption compared to current and non-smokers. Age, sex, BMI, alcohol use, number of comorbidities, employment status and operative time were not significantly associated with number of OMEs consumed at 2- and 6-weeks postoperatively. Patients with a higher number of comorbidities (p=0.006) and those who were employed (p=0.006) reported higher pain scores at 6-weeks. Patients in the ‘not employed/other’ category had significantly lower pain scores at 6-weeks postoperatively (p=0.046). Age, sex, BMI, tobacco use, alcohol use, operative time, number of comorbidities and employment status were not significantly associated with worse VAS scores at either 2- and 6-weeks. Tobacco use status was significantly associated with increased post-operative opioid consumption following knee and shoulder arthroscopy at 2- and 6-weeks postoperatively, with former smokers consuming the largest quantity of opioids. Increased pain was found to be significantly associated with employment status and an increasing number of comorbidities at 6-weeks postoperatively. Particularly, employed patients presented with the highest VAS pain scores while unemployed patients presented with the lowest VAS pain scores. The findings of this analysis can further aid clinicians in identifying and mitigating increased opioid utilization as well as worse pain outcomes in high-risk patient populations undergoing arthroscopic surgery.