Opioid Prescription Refills After Osteochondral Procedures of the Knee

Abstract

(1) To assess the incidence of postoperative opioid prescription refills in patients undergoing osteochondral autograft transplant (OAT) and osteochondral allograft transplant (OCA) procedures of the knee; (2) to evaluate the effect of filling preoperative opioid prescriptions on the incidence of postoperative filling; and (3) to assess the impact of age, sex, and diagnosis of low-back pain on postoperative opioid prescription filling. The Humana administrative claims database was queried for patients undergoing knee OAT and OCA procedures between 2007 and 2017 by use of Current Procedural Terminology codes. Patients were stratified by age, diagnosis of low-back pain, preoperative opioid use, autograft and allograft procedures, and open and arthroscopic procedures. Preoperative opioid users were defined as those having filled an opioid prescription within 3months before surgery. The relative risk (risk ratio) for opioid prescription refills was calculated monthly for 12months. Multivariate logistic regression analysis was performed to determine odds ratios (ORs) at 3, 6, and 12months. We identified 300 patients: 133 (44%) underwent OAT and 167 (56%) underwent OCA procedures. Of the patients, 236 (79%) were aged 49years or younger, and 31% of patients filled opioid prescriptions preoperatively. Of those who filled preoperative opioid prescriptions, 28% were still filling prescriptions 12months after surgery. Multivariate analysis showed an increased risk of opioid prescription filling at 3months (OR, 7.46 [95% confidence interval (CI), 3.26-17.38]), 6months (OR, 15.41 [95% CI, 5.52-41.99]), and 12months (OR, 13.45 [95% CI, 5.41-33.75]) postoperatively in preoperative opioid users. Filling opioid prescriptions preoperatively increased the risk of postoperative filling of opioid prescriptions after cartilage restoration procedures of the knee. Over 30% of patients were found to have filled an opioid prescription preoperatively. Univariate analysis showed that ageof 50years or older and low-back pain increased the risk of postoperative prescription refilling, but only age of 50years or older provided a significantly increased risk at 3months postoperatively using a multivariate analysis. Level III, retrospective case-control study.