Opioid Prescribing Trends and Geographic Variation After Anterior Cruciate Ligament Reconstruction

Abstract

Introduction: Opioid prescribing patterns play an important role in the opioid epidemic in the United States. The purpose of this study is to examine the trends and geographic variation in opioid prescribing patterns after anterior cruciate ligament (ACL) reconstruction.

Hypothesis: Regional differences in opioid prescribing patterns after ACL reconstruction are present.

Study design: Descriptive epidemiology study.

Level of evidence: Level 4.

Methods: The Truven Health MarketScan Commercial Claims database was used to analyze all patients with perioperative private insurance coverage who underwent ACL reconstruction from January 1, 2010, to November 31, 2017. Total number and morphine milligram equivalents per day (MMED) of opioid prescriptions were examined, and regional and statewide variation was assessed.

Results: A total of 90,068 ACL reconstruction patients who underwent surgery between 2010 and 2017 were included in the study. Overall, 67% received an opioid prescription within 30 days of surgery and 17% received an opioid prescription ≥90 MMED. The West (20%) had the highest proportion of patients with an opioid prescription ≥90 MMED and the Northeast had the lowest (12%), P < 0.001. The number of opioid prescriptions as well as proportion of opioid prescriptions ≥90 MMED varied significantly by state, P < 0.001. There was a significant increase in number of opioid prescriptions from 2010 to 2017 (62% in 2010 and 83% in 2017; P < 0.001). A significant change in the proportion of patients being prescribed ≥90 MMED was also present (P = 0.04; 15% in 2010, 17% in 2011, 17% 2012, 17% in 2013, 15% in 2014, 20% in 2015, 18% in 2016, and 15% in 2017).

Conclusion: This study shows a trend of increasing opioid prescriptions and geographic variations in the amount and MMED of opioid prescriptions for patients undergoing ACL reconstruction. These data highlight several areas of improvement that state officials and national entities can use to help curb the opioid epidemic and underscore the importance of national guidelines for opioid prescribing.

Clinical relevance: Knowledge of prescribing patterns after specific procedures may help provide more direct insight and guidance to surgeons and patients regarding postoperative pain management.

Keywords: anterior cruciate ligament reconstruction; geographic variation; opioid abuse; opioids; postoperative pain.

Figure 1.

Flowchart demonstrating exclusion criteria and the final sample used. ACL, anterior cruciate ligament; MME, morphine milligram equivalents.

Figure 2.

Geographic variation in (a) proportion of opioid prescriptions and (b) opioid prescriptions ≥90 MMED within 30 days after anterior cruciate ligament reconstruction. MMED, morphine milligram equivalents per day.

Figure 3.

Annual proportions of patients prescribed opioids and those prescribed high dose opioids (≥90 MMED) by region and their associated 95% logit confidence intervals: (a) Northeast, (b) Midwest, (c) South, and (d) West. MMED, morphine milligram equivalents per day.