Opioid Use Prior to Arthroscopic Rotator Cuff Repair is Associated with Inferior Patient Reported Outcomes and Lower Rates of Achieving Patient Acceptable Symptom State in the Early Postoperative Period.

Abstract

Introduction: Preoperative opioid use is a risk factor for complications and diminished outcomes following rotator cuff repair (RCR). The purpose of this study was to evaluate the influence of preoperative opioid use on clinically relevant parameters of patient reported outcomes (PROs) following RCR.

Methods: A consecutive series of patients undergoing arthroscopic RCR from 2018 to 2020 were included. Preoperative opioid use within one year of surgery was determined and cumulative morphine milligram equivalents (MME) calculated. Preoperative and postoperative PROs at 3 and 6 months included visual analog scale (VAS) for pain, shoulder subjective value (SSV) and American Shoulder and Elbow Surgeons Shoulder Score (ASES). Proportion of patients achieving clinically relevant measures of minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptoms state (PASS) was determined. Multivariate linear regression was used to identify factors associated with PROs.

Results: 760 patients (52% female) with mean age of 60 (range 49-73) years were included. 480 patients (63%) had no history of opioid prescriptions, while 280 (37%) had an opioid prescribed within one year prior to RCR. Preoperative, 3 month, and 6 month PROs were worse in the preoperative opioid cohort compared to opioid naïve (p<0.05). The rate of achieving PASS at 6 months was statistically greater in the opioid naïve cohort than the preoperative opioid used cohort for VAS for pain (58.7% vs 40.2%, p<0.001), and trended toward statistical significance for ASES (39.9% vs 26.7%, p=0.003) and SSV (55.5% vs 45.5%, p=0.031). There were no statistically significant differences in the proportion of patients achieving MCID or SCB at 3 or 6 months for any PRO between cohorts. Multivariate analysis demonstrated that preoperative opioid use was predictive of lower ASES (ß coefficient -7.47 [95% CI -5.2 to -9.7], p<0.001), lower SSV (ß coefficient -7.21 [95% CI -9.61 to -4.8), p<0.001), and higher VAS for pain (ß coefficient 1.07 [95% CI 0.81 to 1.33], p<0.001).

Conclusion: Patients with a history of preoperative opioid use had statistically significant lower rates of achieving PASS for VAS for pain and demonstrated similar trends for ASES and SSV compared to opioid naïve patients in the early postoperative period following arthroscopic RCR. However, there were no differences in the rate of achieving MCID and SCB for ASES, SSV, and VAS for pain between opioid use and opioid naïve cohorts. Preoperative opioid use was a consistent factor associated with inferior outcomes for ASES, SSV, and VAS.