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. 2025 Mar;33(3):856-864.
doi: 10.1002/ksa.12403. Epub 2024 Aug 6.

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

Hassaan Abdel Khalik  1 , Ajaykumar Shanmugaraj  2 , Seper Ekhtiari  1   3 , Nolan S Horner  4 , Aaron Gazendam  3 , Nicole Simunovic  1 , Olufemi R Ayeni  1 ; NO PAin Investigators
Affiliations

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

Hassaan Abdel Khalik et al. Knee Surg Sports Traumatol Arthrosc. 2025 Mar.

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.

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Conflict of interest statement

O. R. A. is on the speaker bureau for Stryker Canada and is the editor‐in‐chief of JISAKOS, Tier 2 Canada Research Chair in Joint Preservation and president/owner of Notch Academy. The remaining authors declare no conflict of interest.

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