Opioid Represcriptions After ACL Reconstruction in Adolescents Are Associated With Subsequent Opioid Use Disorder

Area of Science:

• Orthopedic Surgery
• Pain Management
• Public Health

Background:

• Postoperative opioid prescriptions pose a risk for subsequent opioid use disorders (OUD).
• Pediatric anterior cruciate ligament (ACL) reconstruction rates are increasing.
• Adolescents undergoing ACL reconstruction may experience their first opioid exposure.

Purpose of the Study:

• To analyze opioid prescription patterns following pediatric ACL reconstruction.
• To assess the association between opioid prescribing and the risk of developing OUD in adolescents.

Main Methods:

• Utilized a national administrative claims database (Optum Clinformatics Data Mart).
• Identified patients aged 10-18 undergoing primary ACL reconstruction (2014-2016) with 1-year follow-up.
• Analyzed demographic variables and opioid prescription patterns (MMEs) using logistic regression to predict OUD diagnosis.

Main Results:

• 0.7% of 4459 patients developed OUD within 1 year post-surgery.
• Opioid represcriptions within 6 weeks were significantly more common in patients who developed OUD (27.6% vs. 9.7%).
• Each 100 MME increase in initial prescription raised OUD odds by 13%; represcription within 6 weeks increased OUD odds by 161%.

Conclusions:

• Substantial variability exists in opioid prescribing patterns for pediatric ACL reconstruction.
• Higher initial opioid prescription volume and early refills (within 6 weeks) predict subsequent OUD development.
• Findings highlight the need for cautious opioid prescribing in adolescent orthopedic surgery to mitigate OUD risk.