Development of a clinical risk calculator for prolonged opioid use after shoulder surgery

Nicholson, Allen D.; Kassam, Hafiz F.; Steele, Jacqueline L.; Passarelli, Natalie R; Blaine, Theodore A.; Kovacevic, David

doi:10.1016/j.jse.2019.03.033

Cited by 19 publications

(16 citation statements)

References 13 publications

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“…A study of over 550 patients using a state Prescription Dug Monitoring Program found psychiatric disorders, along with pre-operative opioid use, insurance type, procedure type, body mass index, and smoking status, to be associated with prolonged post-operative opioid use after shoulder surgery. (30) Another study, using the Humana national claims database, showed pre-operative opioid use and depression to be risk factors for chronic postoperative opioid use after common orthopaedic procedures. Specifically, the authors showed an odds ratio of 1.51 (1.28 to 1.77) for chronic postoperative opioid use in patients with depression undergoing rotator cuff repair.…”

Section: Discussionmentioning

confidence: 99%

Increased Health Care Costs and Opioid Use in Patients with Anxiety and Depression Undergoing Rotator Cuff Repair

Cronin

Mair

Hawk

et al. 2020

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Purpose:The purpose of this study was to 1) quantify the prevalence of mood disorders in patients undergoing arthroscopic rotator cuff repair using a large claims database and 2) compare opioid use and medical costs in the year before and the year after rotator cuff repair between those with and without comorbid mood disorders. Methods:The Truven Healthcare Marketscan database was queried to identify those who underwent arthroscopic rotator cuff repair (RCR; CPT code 29827) between October, 2010 and December, 2015. All patients were then screened for insurance claims relating to either anxiety or depression. We then compared net costs and opioid use both one year preoperatively and one year postoperatively between those with and without mood disorders using an analysis of covariance (ANCOVA).Results: A total of 170,329 patients (97,427 males (57.2%) and 72,902 females (42.8%)) undergoing arthroscopic rotator cuff repair were identified. Of the 170,329 patients, 46,737 (27.4%) had comorbid anxiety or depression, and after adjusting for preoperative cost, sex, age, and both preoperative and postoperative opioid use, the one-year postoperative costs for those with a preoperative mood disorder was 7.05% higher than for those without a mood disorder. In addition, opioid use both in the 180 days prior to surgery (36.7% vs. 26.9%) and more than 90 days after surgery (33.0% vs. 27.2%) were substantially greater in the group with comorbid depression or anxiety.

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Section: Discussionmentioning

confidence: 99%

Increased Health Care Costs and Opioid Use in Patients with Anxiety and Depression Undergoing Rotator Cuff Repair

Cronin

Mair

Hawk

et al. 2020

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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“…are at an increased risk of continued and prolonged opioid use after RCR, 35,57,58 with researchers finding similar results in patients undergoing anterior cruciate ligament reconstruction, total joint arthroplasty, and spine surgery. 8,9,40,41,44 Concerning total joint arthroplasty, numerous publications have cited preoperative and perioperative opioid use as risk factors for deleterious outcomes after surgery, noting increased health care utilization and increased rates of prosthetic joint infection and revision surgery.…”

mentioning

confidence: 80%

“…Our findings agree with those identified in total hip and knee arthroplasty studies, which have demonstrated increased rates of infections, 10 revision surgery, 6,7,56 and readmissions 56 in patients taking opioids before surgery. There are several mechanisms by which preoperative opioid use may be driving these complications, including increased postoperative analgesic requirements, 1,35,57,58 unrealistic postoperative expectations for surgery, 34 increased dissatisfaction with surgery, 22,30 and opioid-associated delayed wound healing and impaired immunological functioning. 39,49 Furthermore, we add to the literature another risk factor for detrimental postoperative outcomes in those undergoing RCR, which previously included patient age, 29 body mass index, 5 comorbidities, 46,53 open repair, 38 and preoperative and intraoperative steroid injections.…”

Section: Discussionmentioning

confidence: 99%

“…15,19,27 Opioid use before RCR is common, with a commercial claims database showing that 43% of patients require opioids in the 3 months before surgery. 57 In addition, patients using opioids preoperatively are at an increased risk of continued and prolonged opioid use after RCR, 35,57,58 with researchers finding similar results in patients undergoing anterior cruciate ligament reconstruction, total joint arthroplasty, and spine surgery. 8,9,40,41,44…”

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confidence: 95%

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Preoperative Opioid Use Is a Risk Factor for Revision Surgery, Complications, and Increased Resource Utilization After Arthroscopic Rotator Cuff Repair

et al. 2020

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Background: Studies have shown preoperative opioid use to influence outcomes after various surgical procedures. Researchers have not assessed this relationship after rotator cuff repair (RCR). Hypothesis/Purpose: The purpose of this study was to assess the relationship between preoperative opioid use and outcomes after arthroscopic RCR. We hypothesized that patients prescribed higher daily averages of preoperative oral morphine equivalents (OMEs) would show increased rates of 90-day complications and 3-year revision surgery. Study Design: Cohort study; Level of evidence, 3. Methods: The MarketScan claims database was utilized to identify patients who underwent arthroscopic RCR between 2009 and 2018. We used preoperative opioid use status to divide patients into groups based on the average daily OMEs consumed in the 6 months before surgery: opioid-naïve, <1, 1-<5, 5-<10, and ≥10 OMEs per day. We retrieved 90-day complication and 3-year revision surgery rates. Opioid use groups were then compared with binomial logistic regression and generalized linear models. Results: We identified 214,283 patients. Of those patients, 50.7% did not receive any preoperative opioids, while 7.7%, 26.8%, 6.3%, and 8.6% received <1, 1-<5, 5-<10, and ≥10 OMEs per day over a 6-month time period, respectively. Complications increased with increasing preoperative OMEs. Multivariate analysis revealed that any patient using ≥1 OME per day had increased rates of 3-year revision surgery, reoperations, and infections. Specifically, patients averaging ≥10 OMEs per day showed a 103% (odds ratio, 2.03 [95% CI, 1.62-2.54]; P < .001) increase in the odds of revision surgery compared with opioid-naïve patients. Rates of hospital admissions and postoperative emergency department encounters were higher in all opioid use groups. Adjusted differences in 6-month preoperative and 3-month postoperative health care costs were seen in the opioid use groups compared with opioid-naïve patients, ranging from US$1307 to US$5820 ( P < .001). Conclusion: Preoperative opioid use was a risk factor for complications and revision surgery after arthroscopic RCR. We also observed a dose-dependent response between opioid use and postoperative complications.

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“…Both studies also identified several factors, including fibromyalgia, obesity, and age <65 years, that conferred increased risk of prolonged postoperative opioid use. Furthermore, Nicholson et al 19 constructed a model to preoperatively predict prolonged opioid use after shoulder surgery. The study identified 10 risk factors that were significantly associated with prolonged opioid use, of which preoperative opioid use and insurance type were the strongest.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes Associated With Preoperative Opioid Use in Various Shoulder Surgical Procedures: A Systematic Review

Devano

Smith

Houck

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: The impact of preoperative opioid use on outcomes after shoulder surgery is unknown. Purpose/Hypothesis: To examine the role of preoperative opioid use on outcomes in patients after shoulder surgery. We hypothesized that preoperative opioid use in shoulder surgery will result in increased postoperative pain and functional deficits when compared with nonuse. Study Design: Systematic review; Level of evidence, 3. Methods: A systematic review was performed using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Included were all English-language studies comparing clinical outcomes of shoulder surgery in patients who used opioids preoperatively (opioid group) as well as patients who did not (nonopioid group) with a minimum follow-up of 1 year. Outcomes included range of motion, American Shoulder and Elbow Surgeons score, Constant-Murley score, and visual analog scale for pain. Study quality was evaluated with the Modified Coleman Methodology Score and the MINORS score (Methodological Index for Non-randomized Studies). Results: Included were 5 studies (level 2, n = 1; level 3, n = 4): Two studies were on total shoulder arthroplasty, 2 on reverse total shoulder arthroplasty, 1 on both, and 1 on arthroscopic rotator cuff repair. There were 827 patients overall: 290 in the opioid group (age, 63.2 ± 4.0 years [mean ± SD]; follow-up, 38.9 ± 7.5 months) and 537 in the nonopioid group (age, 66.0 ± 4.7 years; follow-up, 39.5 ± 8.1 months). The opioid group demonstrated significantly worse pre- and postoperative visual analog scale and Constant-Murley score pain scores as compared with the nonopioid group. Mean American Shoulder and Elbow Surgeons scores were significantly lower in the opioid group at pre- and postoperative time points as compared with the nonopioid group ( P < .05 for all). However, both groups experienced similar improvement in outcomes pre- to postoperatively. One study showed that the opioid group consumed significantly more opioids postoperatively than the nonopioid group and for a longer duration ( P < .05). The overall mean Modified Coleman Methodology Score and MINORS score were 64.2 ± 14 and 15.8 ± 1.0, respectively. Conclusion: Opioid use prior to various shoulder surgical procedures negatively affected postoperative pain and functionality. Although the opioid group showed significantly worse scores postoperatively, the groups experienced similar improvements.

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Development of a clinical risk calculator for prolonged opioid use after shoulder surgery

Cited by 19 publications

References 13 publications

Increased Health Care Costs and Opioid Use in Patients with Anxiety and Depression Undergoing Rotator Cuff Repair

Increased Health Care Costs and Opioid Use in Patients with Anxiety and Depression Undergoing Rotator Cuff Repair

Preoperative Opioid Use Is a Risk Factor for Revision Surgery, Complications, and Increased Resource Utilization After Arthroscopic Rotator Cuff Repair

Clinical Outcomes Associated With Preoperative Opioid Use in Various Shoulder Surgical Procedures: A Systematic Review

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