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Opioid Prescription Refills After Osteochondral Procedures of the Knee

      Purpose

      (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.

      Methods

      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 3 months before surgery. The relative risk (risk ratio) for opioid prescription refills was calculated monthly for 12 months. Multivariate logistic regression analysis was performed to determine odds ratios (ORs) at 3, 6, and 12 months.

      Results

      We identified 300 patients: 133 (44%) underwent OAT and 167 (56%) underwent OCA procedures. Of the patients, 236 (79%) were aged 49 years or younger, and 31% of patients filled opioid prescriptions preoperatively. Of those who filled preoperative opioid prescriptions, 28% were still filling prescriptions 12 months after surgery. Multivariate analysis showed an increased risk of opioid prescription filling at 3 months (OR, 7.46 [95% confidence interval (CI), 3.26-17.38]), 6 months (OR, 15.41 [95% CI, 5.52-41.99]), and 12 months (OR, 13.45 [95% CI, 5.41-33.75]) postoperatively in preoperative opioid users.

      Conclusions

      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 age of 50 years or older and low-back pain increased the risk of postoperative prescription refilling, but only age of 50 years or older provided a significantly increased risk at 3 months postoperatively using a multivariate analysis.

      Level of Evidence

      Level III, retrospective case-control study.
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