Predictors of Extended Postoperative Opioid Use in Patients Undergoing Hip Arthroscopy For FAIS

Abstract

To identify predictors of requiring at least one postoperative opioid refill after undergoing hip arthroscopy for femoroacetabular impingement and determine 2-year reported outcomes for those patients. Data from consecutive patients undergoing hip arthroscopy for FAIS from January 2012 to December 2016 were analyzed. Baseline demographics were recorded, along with preoperative opioid use and pre- and 2-year postoperative functional outcomes scores including the Hip Outcome Score-Activity of Daily Living (HOS-ADL), HOS-Sports Subscale (HOS-SS), modified hip Harris score (mHHS), international hip outcome tool (iHOT-12), and visual analog score (VAS) for pain and satisfaction. A correlation analysis was used to identify variables associated with requiring postoperative opioid refill. Statistically significant variables (p>0.05) were included in a final logistic regression model. 775 patients with postoperative opioid use and 2-year follow-up were included in the analysis. 141 (18.2%) patients required at least one postoperative opioid prescription refill. Patients requiring refills had significantly lower HOS-ADL (79.9+-20.3 vs 88.7+-14.9), HOS-SS (64.6+-29.5 vs 78.2+-23.7), mHHS (74.2+-21.1 vs 83.6+-15.9), iHOT-12(63.6+-27.9 vs 74.9+-24.8), and VAS satisfaction (73.4+-30.3 vs 82.2+-24.9), as well as higher pain (26.8+-23.4 vs 17.9+-21.8) with p<0.001 for all outcomes. Predictors of requiring additional postoperative opioids included patients with a history of opioid use prior to surgery (OR: 4.04; 95%CI: 1.99-8.19) and larger preoperative alpha angles (OR:1.04; 95%CI: 1.01-1.07). Sub-analysis by past versus current opioid use at the time of surgery demonstrated that current use was predictive of requiring additional postoperative opioids (OR:3.12; 95%CI: 1.06-9.21; p=0.039), while past opioid use for was not. Patients requiring at least one postoperative opioid refill after undergoing hip arthroscopy for FAIS have lower 2-year functional scores when compared to patients not requiring refills. Additionally, active pre-operative opioid use at the time of surgery, as well as larger preoperative alpha angles are predictors of requiring additional opioids for pain management.