Risk Factors for Opioid Use after Patellofemoral Stabilization Surgery: Analyses of 1,316 Cases

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Orthopaedic surgeons are the third-highest group of opioid prescribers among all physicians in the United States, accounting for almost 8% of all opioid prescriptions. Given the recent opioid epidemic, identification of risk factors for prolonged opioid use after knee procedures may benefit patients and providers. Risk factors for increased postoperative opioid utilization following patellar stabilization surgery have yet to be fully delineated, especially in young, active patient populations at increased risk of abuse misuse. This study investigated risk factors for postoperative opioid use following patellofemoral stabilization surgery. Patients undergoing primary patellar stabilization surgery between 2007-2017 in the Humana Inc. administrative claims database were identified using Current Procedural Terminology (CPT) codes for patellofemoral stabilization procedures (CPT-27420, 27422, 27427, 27418). Patients were categorized into opioid naive (N-OU) and those who filled opioid prescriptions within 3 months prior to surgery (OU). Patients in the OU cohort were further categorized into those who filled prescriptions at 1-3 months before surgery (C-OU) and those who filled opioid prescriptions only in the month preceding surgery (A-OU). Descriptive statistics and multivariate analyses were performed to identify risk factors for postoperative opioid use at 3 and 12 months using the open-source R software (www.r-project.org) housed within Pearl Diver with statistical significance defined as p < 0.05. A total of 1,316 eligible patients were included. One year postoperatively, there was a greater risk of opioid consumption in the OU cohort (OU vs N-OU: 22.2% vs 4.1%; Relative Risk [RR]: 1.233; 95% CI: 1.172- 1.298; P < 0.0001). C-OU (OR: 5.74; 95% CI: 3.75- 8.9; P < 0.0001), obesity (OR: 1.76; 95% CI: 1.14- 2.69; P = 0.0099), and history of a psychiatric diagnosis (OR: 1.83; 95% CI: 1.01- 3.25; P = 0.0435) were independent risk factors for opioid use at 12 months postoperatively. Younger age (age < 30) was associated with a lower risk of opioid use at 3 months (OR: 0.3, 95% CI: 0.21- 0.44; P < 0.0001) and 12 months (OR: 0.29; 95% CI: 0.17- 0.46; P < 0.0001) postoperatively. Preoperative opioid utilization significantly increased opioid prescription filling following patellofemoral stabilization surgery. Given the relatively young age and high activity level of patients undergoing patellofemoral stabilization surgery, heightened awareness of patient-specific factors must be considered when selecting appropriate pain management regimens postoperatively.