• Robert D Wojahn, Ljiljana Bogunovic, Robert H Brophy, Rick W Wright, Matthew J Matava, John R Green, Corinne A Zalomek, Amanda K Haas, Wendy L Holloway, Elizabeth A Garofoli, and Matthew V Smith.
• Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri.
• J Bone Joint Surg Am. 2018 Oct 3; 100 (19): 1629-1636.

BackgroundThe opioid epidemic in the United States has placed increased pressure on physicians to engage in responsible opioid prescribing practices. However, surgeons currently have little information to guide their postoperative prescription decision-making. The purpose of this study was to assess opioid consumption after knee arthroscopy and identify preoperative factors that may predict higher opioid usage.MethodsA prospective observational study of 221 patients was conducted in patients undergoing outpatient knee arthroscopy for meniscal repair, partial meniscectomy, debridement, chondroplasty, or loose body removal. Participants recorded their daily opioid consumption in a postoperative pain diary. Total opioid consumption was calculated from counts of remaining pills at the 2-week and 6-week postoperative office visits. Variables, including age, sex, body mass index, smoking status, alcohol consumption, preoperative pain severity and duration, preoperative opioid usage, Patient-Reported Outcomes Measurement Information System (PROMIS) scores, and the Connor-Davidson Resilience Scale, were evaluated for an association with opioid consumption.ResultsTotal opioid consumption ranged from 0 to 188 pills, with a median of 7 pills (hydrocodone 5-mg equivalents). Forty-six percent of patients took ≤5 pills, 59% took ≤10 pills, and 81% took ≤20 pills. Fifty-six percent of patients had discontinued opioid usage by the third postoperative day. Eighty-eight percent of patients had surplus opioid medication at the time of the final follow-up. Patients undergoing meniscal repair, smokers, and those taking preoperative opioids were significantly more likely to take ≥20 pills (p < 0.05).ConclusionsThe median number of pills taken after knee arthroscopy is 7, with the majority of patients consuming ≤20 pills. Meniscal repair, smoking, and preoperative opioid usage were associated with higher postoperative opioid consumption.Level Of EvidencePrognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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