Grit is not associated with opioid consumption patterns in patients that undergo arthroscopic rotator cuff repair

The aim of this study was to determine whether patient grit is associated with postoperative opioid consumption and pain/functional outcomes following primary arthroscopic rotator cuff repair (ARCR).

This is a prospective longitudinal study set in a single ambulatory surgical center in a large metropolitan area. Patients aged 18 or older undergoing primary ARCR were enrolled starting December 2019 with a target sample size of N = 120. Patients were excluded on the basis of chronic opioid use, worker's compensation, and concomitant operation including any of the following procedures: Bankart repair, superior labrum anterior to posterior repair, posterior-inferior labral repair, and open reduction internal fixation. All patients received the same postoperative pain protocol: 1-2 pills of oxycodone 5 mg every 4 hours, 3 pills of ibuprofen 200 mg every 8 hours, and 2 pills of acetaminophen 500 mg every 8 hours (all as needed).The primary outcome was morphine milligram equivalents (MMEs) consumed within the first 2 weeks after surgery. Secondary outcomes included preoperative and postoperative 12-item Grit score (Grit-12), Brief Resilience Score (BRS), Pain Catastrophizing Scale (PCS), pain scale, and visual analog scale (VAS) pain score. Bivariate Pearson and Spearman correlations were conducted between Grit-12 score and (1) MMEs, (2) BRS, (3) PCS, and (4) VAS pain score for the affected shoulder.

Of the 142 enrolled patients, a total of 120 patients (84.5%) completed the study protocol. Grit-12 score was not associated with MMEs at 2 weeks postoperative (r = 0.06), and there was no statistical difference (P ≥ .172) in MMEs consumed at any time point between high-grit (above the median MME) and low-grit patients (below the median MME). Furthermore, there was no significant correlation between preoperative Grit-12 and preoperative BRS (r = -0.12, [-0.29, 0.06], P = .206), preoperative PCS (r = -0.01, [-0.20, 0.17], P = .882), or postoperative VAS score (r = -0.01, [-0.19, 0.17], P = .903). The cohort was mostly male (62.7%) with an average age of 62.2 ± 7.8. Overall mode of MME for patients that took opioid pain medication at 24 hours, 48 hours, 72 hours, and 2 weeks was 45, 30, 15, and 52.5 MME, respectively. Approximately 17.0% of patients required oxycodone refills with no difference between high- and low-grit patients (P = .464).

Although perseverance and resiliency have been associated with better ability to handle adversity, there seems to be no association between patient grit or resiliency scores and opioid consumption during the first 2 weeks following ARCR.