title: Prolonged opioid use after knee arthroscopy in military veterans.
abstract: BACKGROUND
  Chronic postoperative pain occurs with an appreciable incidence after elective surgery. Known risk factors include perioperative pain and posttraumatic stress disorder (PTSD). Military veterans are a population at particular risk for PTSD and hence may be at increased risk for chronic pain after surgery. Our goal was to identify risk factors for chronic postoperative pain in young veterans after minor elective surgery, including the contribution of PTSD.
  
  
  METHODS
  We reviewed the medical and pharmacy records of veterans (18-50 years old), undergoing elective knee arthroscopy from 2007 to 2010 at the Veteran's Administration Puget Sound Health Care System. The data included demographics, ASA physical status class, comorbidities, anesthesia medications, and opioid prescriptions starting 3.5 months before surgery and ending 3.5 months after surgery. We documented the presence of PTSD based on either the patient's problem list or the clinical notes. We used prolonged postoperative opioid prescription longer than 3 months after surgery as a surrogate for chronic postoperative pain.
  
  
  RESULTS
  We identified 145 patients who met inclusion criteria. The median age was 39 ± 8 years old. Eighty-seven percent of the patients were men. The prevalence of PTSD was 32% (95% confidence interval, 25%-41%). PTSD was associated with increased incidence of smoking (P = 0.009) and preoperative opioid use (P = 0.0006). Preoperative opioids were prescribed in 44% (63 of 145) of the patients: in 64% (30 of 47) of patients with PTSD, compared with 34% (33 of 98) in patients without PTSD (P = .0006). Chronic postoperative pain was identified in 30% (43 of 145) of patients. The strongest independent predictor of chronic postoperative pain was an opioid prescription before surgery (odds ratio = 65.3; 95% confidence interval, 014.5-293.0). In patients older than 27.5 years who did not receive opioids before surgery, PTSD may also have been a risk factor for chronic postoperative pain.
  
  
  CONCLUSIONS
  This single-center retrospective study suggests that the most important predictor of chronic postoperative pain is preoperative opioid use. For patients not taking opioids preoperatively, PTSD may increase the risk of prolonged postoperative opioid prescriptions and chronic postoperative pain, potentially related to patient age.
authors: From the Department of Anesthesiology and Pain Medicine, University of Washington; Department of Veterans Affairs, Puget Sound Health Care System, Seattle, Washington; and Department of Quantitative Health Sciences, Health Outcomes and Clinical Epidemiology, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio.
authors: Irene
authors: I
authors: Rozet
authors: Isuta
authors: I
authors: Nishio
authors: Reinette
authors: R
authors: Robbertze
authors: Douglas
authors: D
authors: Rotter
authors: Howard
authors: H
authors: Chansky
authors: Adrian V
authors: AV
authors: Hernandez
mesh_terms: D000328:Adult; D000367:Age Factors; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D001182:Arthroscopy / Q000009:adverse effects*; D059350:Chronic Pain / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D004334:Drug Administration Schedule; D011307:Drug Prescriptions; D005260:Female; D006801:Humans; D015994:Incidence; D007719:Knee Joint / Q000601:surgery*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome; D014728:Veterans; D014861:Washington / Q000453:epidemiology
chemical_list: D000701:Analgesics, Opioid