# Preoperative anxiety differentiates post‐surgical opioid use in patients undergoing anterior cruciate ligament reconstruction

## TL;DR

Preoperative anxiety in female patients increases opioid use after ACL surgery, suggesting psychological factors matter more than biological ones.

## Contribution

Identifies preoperative anxiety as a unique predictor of opioid use in females after ACLR, independent of biological or demographic factors.

## Key findings

- Females with preoperative anxiety used significantly more opioids post-surgery than those without anxiety.
- Anxiety, not depression, was linked to higher opioid intake in females undergoing ACLR.
- Opioid use was similar between males and females, and across age and graft types.

## Abstract

Opioids prescribed to reduce pain and aid in recovery following anterior cruciate ligament reconstruction (ACLR) may pose a risk of future substance use disorder. The purpose of this study was to determine if pre‐operative anxiety and depression differentiated opioid intake following ACLR. The contribution of sex, age, and graft type to post‐operative opioid usage was also explored.

Data from 237 participants (M = 30.75 ± 13.29 years; 57% females; 76% all‐soft tissue quadriceps tendon autograft) were analysed. Four‐item Anxiety and Depression Patient Reported Outcomes Measurement Information System (PROMIS) scales were administered on the day of surgery, and opioid intake was assessed post‐operatively. Patients were classified into 'anxious' or 'depressed' groups based on their PROMIS scores.

Patients took an average of one opioid pill daily. Females with pre‐operative anxiety reported significantly greater post‐operative opioid intake (M = 4.40 ± 3.98) than females with no anxiety (M = 2.90 ± 3.97) (W = 2199, p = 0.03; d = 0.36). No other significant effects were found (p > 0.05).

Anxiety, but not depression, was a risk factor for elevated opioid use in females undergoing ACLR. Interestingly, opioid intake between males and females, as well as by age and graft type, were comparable overall, indicating the unique influence of psychological rather than biological or demographic factors on opioid use following ACLR. Clinicians should consider biopsychosocial assessments to support preoperative opioid counselling, particularly in females with anxiety undergoing ACLR.

Level IV.