Self-defined former smokers consume the highest opioid quantities following knee and shoulder arthroscopy

Hassaan Abdel Khalik; Ajaykumar Shanmugaraj; Seper Ekhtiari; Nolan S Horner; Aaron Gazendam; Nicole Simunovic; Olufemi R Ayeni; NO PAin Investigators

doi:10.1002/ksa.12403

Self-defined former smokers consume the highest opioid quantities following knee and shoulder arthroscopy

Knee Surg Sports Traumatol Arthrosc. 2024 Aug 6. doi: 10.1002/ksa.12403. Online ahead of print.

Authors

Hassaan Abdel Khalik¹, Ajaykumar Shanmugaraj², Seper Ekhtiari^{1

3}, Nolan S Horner⁴, Aaron Gazendam³, Nicole Simunovic¹, Olufemi R Ayeni¹; NO PAin Investigators

Affiliations

¹ Department of Surgery, Division of Orthopaedics, McMaster University, Hamilton, Ontario, Canada.
² University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada.
³ Department of Surgery, Division of Orthopaedic Surgery, University of Toronto, Toronto, Ontario, Canada.
⁴ Genesis Orthopedics and Sports Medicine, Chicago, Illinois, USA.

PMID: 39105443
DOI: 10.1002/ksa.12403

Abstract

Purpose: To identify risk factors associated with increased postoperative opioid consumption and inferior pain outcomes following knee and shoulder arthroscopy.

Methods: Using the data set from the NonOpioid Prescriptions after Arthroscopic Surgery in Canada (NO PAin) trial, eight prognostic factors were chosen a priori to evaluate their effect on opioid consumption and patient-reported pain following arthroscopic knee and shoulder surgery. The primary outcome was the number of oral morphine equivalents (OMEs) consumed at 2 and 6 weeks postoperatively. The secondary outcome was patient-reported postoperative pain using the Visual Analogue Scale (VAS) at 2 and 6 weeks postoperatively. A multivariable linear regression was used to analyse these outcomes with eight prognostic factors as independent variables.

Results: Tobacco usage was significantly associated with higher opioid usage at 2 (p < 0.001) and 6 weeks (p = 0.02) postoperatively. Former tobacco users had a higher 2-week (p = 0.002) and cumulative OME (p = 0.002) consumption compared to current and nonsmokers. Patients with a higher number of comorbidities (p = 0.006) and those who were employed (p = 0.006) reported higher pain scores at 6 weeks. Patients in the 'not employed/other' category had significantly lower pain scores at 6 weeks postoperatively (p = 0.046).

Conclusion: Former smoking status was significantly associated with increased post-operative opioid consumption following knee and shoulder arthroscopy at 2 and 6 weeks postoperatively. Increased pain was found to be significantly associated with employment status and an increasing number of comorbidities at 6 weeks postoperatively. These findings can aid clinicians in identifying and mitigating increased opioid utilization as well as worse pain outcomes in high-risk patient populations.

Level of evidence: Level III, cohort study.

Keywords: knee arthroscopy; multimodal analgesia; opioid consumption; postoperative pain; shoulder arthroscopy.

Grants and funding

None