{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,8]],"date-time":"2025-07-08T10:29:36Z","timestamp":1751970576684,"version":"3.37.3"},"reference-count":37,"publisher":"Oxford University Press (OUP)","issue":"7-8","funder":[{"DOI":"10.13039\/100003896","name":"Henry M. Jackson Foundation","doi-asserted-by":"publisher","award":["#HU00011920042"],"award-info":[{"award-number":["#HU00011920042"]}],"id":[{"id":"10.13039\/100003896","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100003896","name":"Henry M. Jackson Foundation","doi-asserted-by":"publisher","award":["#HU00011920042"],"award-info":[{"award-number":["#HU00011920042"]}],"id":[{"id":"10.13039\/100003896","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,7,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Postsurgical opioid utilization may be directly and indirectly associated with a range of patient-related and surgery-related factors, above and beyond pain intensity. However, most studies examine postsurgical opioid utilization without accounting for the multitude of co-occurring relationships among predictors. Therefore, this study aimed to identify factors associated with opioid utilization in the first 2 weeks after arthroscopic surgery and examine the relationship between discharge opioid prescription doses and acute postsurgical outcomes<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>In this prospective longitudinal observational study, 110 participants undergoing shoulder or knee arthroscopies from August 2016 to August 2018 at Walter Reed National Military Medical Center completed self-report measures before and at 14\u2009days postoperatively. The association between opioid utilization and both patient-level and surgery-related factors was modeled using structural equation model path analysis.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Participants who were prescribed more opioids took more opioids, which was associated with worse physical function and sleep problems at day 14, as indicated by the significant indirect effects of discharge opioid dose on day 14 outcomes. Additional patient-level and surgery-related factors were also significantly related to opioid utilization dose and day 14 outcomes. Most participants had opioid medications leftover at day 14.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Excess opioid prescribing was common, did not result in improved pain alleviation, and was associated with poorer physical function and sleep 14\u2009days after surgery. As such, higher prescribed opioid doses could reduce subacute functioning after surgery, without benefit in reducing pain. Future patient-centered studies to tailor opioid postsurgical prescribing are needed.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/milmed\/usad495","type":"journal-article","created":{"date-parts":[[2024,4,11]],"date-time":"2024-04-11T13:39:12Z","timestamp":1712842752000},"page":"e1771-e1778","source":"Crossref","is-referenced-by-count":1,"title":["Discharge Opioid Dose Indirectly Associated With Functional Outcomes 2 Weeks After Shoulder and Knee Arthroscopy in a US Military Sample"],"prefix":"10.1093","volume":"189","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5623-8075","authenticated-orcid":false,"given":"Germaine F","family":"Herrera","sequence":"first","affiliation":[{"name":"Defense and Veterans Center for Integrative Pain Management, Department of Anesthesiology, Uniformed Services University , Bethesda, MD 20814, USA"},{"name":"Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc , Rockville, MD 20852, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeanne C","family":"Patzkowski","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Brooke Army Medical Center , Fort Sam Houston, TX 78234-6200, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6201-3793","authenticated-orcid":false,"given":"Michael S","family":"Patzkowski","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Brooke Army Medical Center , Fort Sam Houston, TX 78234-6200, USA"},{"name":"Department of Anesthesiology, Uniformed Services University , Bethesda, MD 20814, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicholas A","family":"Giordano","sequence":"additional","affiliation":[{"name":"Nell Hodgson Woodruff School of Nursing, Emory University , Atlanta, GA 30322, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5832-4495","authenticated-orcid":false,"given":"Maya","family":"Scott-Richardson","sequence":"additional","affiliation":[{"name":"Independent Researcher , Bethesda, MD 20800, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Kent","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Duke University Medical Center , Durham, NC 27710, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3815-2571","authenticated-orcid":false,"given":"Krista B","family":"Highland","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Uniformed Services University , Bethesda, MD 20814, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2024,4,11]]},"reference":[{"issue":"3","key":"2024070405060189500_R1","doi-asserted-by":"publisher","first-page":"374","DOI":"10.1016\/j.jamcollsurg.2018.06.007","article-title":"Spillover effect of evidence-based postoperative opioid prescribing","volume":"227","author":"Howard","year":"2018","journal-title":"J Am Coll Surg"},{"issue":"13","key":"2024070405060189500_R2","doi-asserted-by":"publisher","first-page":"1299","DOI":"10.1001\/jama.2011.401","article-title":"Characteristics of opioid prescriptions in 2009","volume":"305","author":"Volkow","year":"2011","journal-title":"JAMA"},{"issue":"5","key":"2024070405060189500_R3","doi-asserted-by":"publisher","first-page":"267","DOI":"10.5435\/JAAOS-D-14-00163","article-title":"The opioid epidemic: impact on orthopaedic surgery","volume":"23","author":"Morris","year":"2015","journal-title":"J Am Acad Orthop Surg"},{"issue":"12","key":"2024070405060189500_R4","doi-asserted-by":"publisher","first-page":"1195","DOI":"10.1001\/jamapediatrics.2016.2154","article-title":"National trends in hospitalizations for opioid poisonings among children and adolescents, 1997 to 2012","volume":"170","author":"Gaither","year":"2016","journal-title":"JAMA Pediatr"},{"issue":"3","key":"2024070405060189500_R5","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.1108","article-title":"The role of the household in prescription opioid safety","volume":"3","author":"Worsham","year":"2020","journal-title":"JAMA Network Open"},{"issue":"11","key":"2024070405060189500_R6","doi-asserted-by":"publisher","first-page":"1066","DOI":"10.1001\/jamasurg.2017.0831","article-title":"Prescription opioid analgesics commonly unused after surgery: a systematic review","volume":"152","author":"Bicket","year":"2017","journal-title":"JAMA Surgery"},{"issue":"10","key":"2024070405060189500_R7","doi-asserted-by":"publisher","first-page":"2681","DOI":"10.1016\/j.arthro.2020.06.014","article-title":"Preoperative opioid use predicts prolonged postoperative opioid use and inferior patient outcomes following anterior cruciate ligament reconstruction","volume":"36","author":"Forlenza","year":"2020","journal-title":"Arthroscopy"},{"issue":"7","key":"2024070405060189500_R8","doi-asserted-by":"publisher","first-page":"829","DOI":"10.1093\/pm\/pnac203","article-title":"Acute postoperative pain impact trajectories and factors contributing to trajectory membership","volume":"24","author":"Giordano","year":"2023","journal-title":"Pain Med"},{"issue":"11","key":"2024070405060189500_R9","doi-asserted-by":"publisher","first-page":"845","DOI":"10.1097\/ajp.0000000000000876","article-title":"Risk factors for increased postoperative pain and recommended orderset for postoperative analgesic usage","volume":"36","author":"Armstrong","year":"2020","journal-title":"Clin J Pain"},{"issue":"1","key":"2024070405060189500_R10","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s13018-019-1446-9","article-title":"Preoperative sleep quality affects postoperative pain and function after total joint arthroplasty: a prospective cohort study","volume":"14","author":"Luo","year":"2019","journal-title":"J Orthopaedic Surg Res"},{"key":"2024070405060189500_R11","doi-asserted-by":"publisher","first-page":"269","DOI":"10.1016\/j.sleep.2019.06.012","article-title":"Opioids and sleep\u2013a review of literature","volume":"67","author":"Tripathi","year":"2020","journal-title":"Sleep Med"},{"issue":"6","key":"2024070405060189500_R12","doi-asserted-by":"publisher","first-page":"700","DOI":"10.1177\/0310057X1704500609","article-title":"Prevalence and predictors of persistent post-surgical opioid use: a prospective observational cohort study","volume":"45","author":"Stark","year":"2017","journal-title":"Anaesth Intensive Care"},{"author":"Services CfMM","article-title":"Delivering value-based transformation in primary care","key":"2024070405060189500_R13"},{"issue":"1","key":"2024070405060189500_R14","article-title":"What is value-based healthcare?","volume":"3","author":"Catalyst","year":"2017","journal-title":"NEJM Catal"},{"issue":"6","key":"2024070405060189500_R15","doi-asserted-by":"publisher","first-page":"274","DOI":"10.24015\/JAPM.2017.0081","article-title":"Patient-Reported Outcome Measures (PROM) as a preoperative assessment tool","volume":"4","author":"Kim","year":"2017","journal-title":"J Anesth Perioper Med"},{"issue":"1","key":"2024070405060189500_R16","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1016\/j.sjpain.2016.02.008","article-title":"New approach for treatment of prolonged postoperative pain: APS out-patient clinic","volume":"12","author":"Tiippana","year":"2016","journal-title":"Scand J Pain"},{"key":"2024070405060189500_R17","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1016\/j.jclinepi.2015.08.038","article-title":"PROMIS measures of pain, fatigue, negative affect, physical function, and social function demonstrated clinical validity across a range of chronic conditions","volume":"73","author":"Cook","year":"2016","journal-title":"J Clin Epidemiol"},{"key":"2024070405060189500_R18","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1016\/j.jclinepi.2015.08.03","article-title":"The PROMIS satisfaction with social participation measures demonstrated responsiveness in diverse clinical populations","volume":"73","author":"Hahn","year":"2016","journal-title":"J Clin Epidemiol"},{"issue":"23","key":"2024070405060189500_R19","doi-asserted-by":"publisher","first-page":"E1357","DOI":"10.1097\/BRS.0000000000002347","article-title":"Concurrent validity and responsiveness of PROMIS health domains among patients presenting for anterior cervical spine surgery","volume":"42","author":"Purvis","year":"2017","journal-title":"Spine"},{"key":"2024070405060189500_R20","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1016\/j.jclinepi.2015.08.036","article-title":"Clinical validity of PROMIS depression, anxiety, and anger across diverse clinical samples","volume":"73","author":"Schalet","year":"2016","journal-title":"J Clin Epidemiol"},{"key":"2024070405060189500_R21","doi-asserted-by":"publisher","first-page":"194","DOI":"10.1016\/j.jclinepi.2015.08.029","article-title":"PROMIS fatigue, pain intensity, pain interference, pain behavior, physical function, depression, anxiety, and anger scales demonstrate ecological validity","volume":"74","author":"Stone","year":"2016","journal-title":"J Clin Epidemiol"},{"issue":"11","key":"2024070405060189500_R22","doi-asserted-by":"publisher","first-page":"2291","DOI":"10.1016\/j.apmr.2013.05.014","article-title":"Upper-extremity and mobility subdomains from the Patient-Reported Outcomes Measurement Information System (PROMIS) adult physical functioning item bank","volume":"94","author":"Hays","year":"2013","journal-title":"Arch Phys Med Rehabil"},{"issue":"1","key":"2024070405060189500_R23","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/10705519909540118","article-title":"Cut-off criteria for fit indexes in covariance structure analysis: convenfional criteria versus new alternafives, structural equafion modelling","volume":"6","author":"Hu","year":"1999","journal-title":"Ref Bibliogr\u00e1fica"},{"issue":"3","key":"2024070405060189500_R24","doi-asserted-by":"publisher","first-page":"636","DOI":"10.1177\/0363546517693665","article-title":"Unused opioid pills after outpatient shoulder surgeries given current perioperative prescribing habits","volume":"45","author":"Kumar","year":"2017","journal-title":"Am J Sports Med"},{"issue":"2","key":"2024070405060189500_R25","doi-asserted-by":"publisher","first-page":"355e","DOI":"10.1097\/01.prs.0000475788.52446.7b","article-title":"The utilization of opioid analgesics following common upper extremity surgical procedures: a national, population-based study","volume":"137","author":"Waljee","year":"2016","journal-title":"Plast Reconst Surg"},{"issue":"3","key":"2024070405060189500_R26","doi-asserted-by":"publisher","first-page":"469","DOI":"10.1097\/SLA.0000000000002198","article-title":"An educational intervention decreases opioid prescribing after general surgical operations [published online ahead of print March 6, 2017]","volume":"267","author":"Hill","year":"2018","journal-title":"Ann Surg"},{"issue":"3","key":"2024070405060189500_R27","doi-asserted-by":"publisher","first-page":"310","DOI":"10.1016\/j.bjane.2014.09.005","article-title":"Good clinical practice guide for opioids in pain management: the three Ts-titration (trial), tweaking (tailoring), transition (tapering)","volume":"66","author":"Coluzzi","year":"2016","journal-title":"Rev Bras de Anestesiol"},{"issue":"3","key":"2024070405060189500_R28","doi-asserted-by":"publisher","first-page":"273","DOI":"10.1016\/j.smrv.2013.07.002","article-title":"Postoperative sleep disruptions: a potential catalyst of acute pain?","volume":"18","author":"Chouchou","year":"2014","journal-title":"Sleep Med Rev"},{"issue":"4","key":"2024070405060189500_R29","doi-asserted-by":"publisher","first-page":"939","DOI":"10.1213\/ANE.0b013e3182860e58","article-title":"Occurrence of rapid eye movement sleep deprivation after surgery under regional anesthesia","volume":"116","author":"Dette","year":"2013","journal-title":"Anesthesia Analg"},{"issue":"5","key":"2024070405060189500_R30","doi-asserted-by":"publisher","first-page":"1051","DOI":"10.1177\/0363546519837516","article-title":"Elective shoulder surgery in the opioid na\u00efve: rates of and risk factors for long-term postoperative opioid use","volume":"47","author":"Leroux","year":"2019","journal-title":"Am J Sports Med"},{"issue":"7","key":"2024070405060189500_R31","doi-asserted-by":"publisher","first-page":"S147","DOI":"10.1016\/j.arth.2017.10.060","article-title":"Trends in opioid utilization before and after total knee arthroplasty","volume":"33","author":"Politzer","year":"2018","journal-title":"J Arthroplasty"},{"issue":"9","key":"2024070405060189500_R32","doi-asserted-by":"publisher","first-page":"1286","DOI":"10.1001\/jamainternmed.2016.3298","article-title":"Incidence of and risk factors for chronic opioid use among opioid-naive patients in the postoperative period","volume":"176","author":"Sun","year":"2016","journal-title":"JAMA Intern Med"},{"issue":"19","key":"2024070405060189500_R33","doi-asserted-by":"publisher","first-page":"1629","DOI":"10.1016\/j.arthro.2020.10.019","article-title":"Opioid consumption after knee arthroscopy","volume":"100","author":"Wojahn","year":"2018","journal-title":"Jbjs"},{"issue":"8","key":"2024070405060189500_R34","doi-asserted-by":"publisher","first-page":"810","DOI":"10.1055\/s-0039-3400754","article-title":"Opioid requirement following arthroscopic knee surgery: are there predictive factors associated with long-term use","volume":"34","author":"Glogovac","year":"2019","journal-title":"J Knee Surg"},{"issue":"1","key":"2024070405060189500_R35","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1001\/jamasurg.2017.3132","article-title":"Defining optimal length of opioid pain medication prescription after common surgical procedures","volume":"153","author":"Scully","year":"2018","journal-title":"JAMA Surg"},{"issue":"4","key":"2024070405060189500_R36","doi-asserted-by":"publisher","first-page":"1044","DOI":"10.1213\/ANE.0000000000003342","article-title":"A dedicated acute pain service is associated with reduced postoperative opioid requirements in patients undergoing cytoreductive surgery with hyperthermic intraperitoneal chemotherapy","volume":"127","author":"Said","year":"2018","journal-title":"Anesth Analg"},{"issue":"11","key":"2024070405060189500_R37","doi-asserted-by":"publisher","first-page":"50","DOI":"10.1097\/01.NAJ.0000473315.02325.b4","article-title":"Prescription opioid analgesics promoting patient safety with better patient education","volume":"115","author":"Costello","year":"2015","journal-title":"Am J Nurs"}],"container-title":["Military Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/milmed\/article-pdf\/189\/7-8\/e1771\/58435469\/usad495.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/milmed\/article-pdf\/189\/7-8\/e1771\/58435469\/usad495.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,7,4]],"date-time":"2024-07-04T05:06:54Z","timestamp":1720069614000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/milmed\/article\/189\/7-8\/e1771\/7644113"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4,11]]},"references-count":37,"journal-issue":{"issue":"7-8","published-online":{"date-parts":[[2024,4,11]]},"published-print":{"date-parts":[[2024,7,3]]}},"URL":"https:\/\/doi.org\/10.1093\/milmed\/usad495","relation":{},"ISSN":["0026-4075","1930-613X"],"issn-type":[{"type":"print","value":"0026-4075"},{"type":"electronic","value":"1930-613X"}],"subject":[],"published-other":{"date-parts":[[2024,7]]},"published":{"date-parts":[[2024,4,11]]}}}