The effect of preoperative education on opioid consumption in patients undergoing arthroscopic rotator cuff repair: a prospective, randomized clinical triald-2-year follow-up

Background: With the recent opioid epidemic in the United States, measures by both government and medical providers are being taken to decrease the opioid dependence rate. Different methods have been proposed, including patient education and multimodal pain therapies. The purpose of this study was to determine whether preoperative opioid education reduces the risk of opioid dependence at 2 years following arthroscopic rotator cuff repair (ARCR). Methods: This study was a 2-year follow-up of the 2018 Neer Award study that demonstrated the use of preoperative opioid education as a means to reduce postoperative opioid consumption after ARCR at 3-month follow-up. This was a prospective, single-center, single-blinded, parallel-group, 2-arm, randomized clinical trial with a 1:1 allocation ratio. To study the effect of preoperative opioid education on opioid dependence at 2 years, we randomized patients into 2 cohorts, a study cohort and a control cohort. Data were obtained with a review of prescription data-monitoring software and a patient telephone interview. Results: Opioid education (P=.03; odds ratio, 0.37; 95% confidence interval, 0.14-0.90) was found to be an independent factor that is protective against opioid dependence. Study patients had a lower rate of opioid dependence (11.4%, 8 of 50) than control patients (25.7%, 18 of 50) (P=.05). Significantly fewer prescriptions were filled by study patients (mean, 2.9) than by control patients (mean, 6.3) (P=.03). Additionally, fewer pills were consumed by study patients (median, 60; interquartile range [IQR], 30, 132) than by control patients (median, 120; IQR, 30, 340) (P=.10). Finally, fewer morphine milligram equivalents were consumed by study patients (median, 375; IQR, 199, 1496) than by control patients (median, 725; IQR, 150, 2190) (P=.27). Conclusion: Our study found that patients who were preoperatively educated on opioid use were less likely to become opioid dependent at 2-year follow-up. Therefore, we demonstrated that opioid education does impart significant long-term benefits to patients undergoing ARCR. Level of evidence: Level I; Randomized Controlled Trial; Treatment Study (C) 2020 Published by Elsevier Inc. on behalf of Journal of Shoulder and Elbow Surgery Board of Trustees.