Diagnosis can predict opioid usage and dependence in reverse shoulder arthroplasty

Abstract

Introduction: Reverse shoulder arthroplasty (RSA) has seen exponential growth over the past 2 decades. In addition, the recent focus on opioid usage and dependence has led to an increased understanding of the risk factors that lead to dependence. The purpose of this study was to examine associations between diagnosis and opioid consumption and dependence in RSA. Methods: A retrospective review was performed of 441 patients who had undergone a primary RSA from 2012 to 2016. Demographics were collected and patients were categorized based on top 4 diagnoses: glenohumeral osteoarthritis (n ¼ 129), irreparable rotator cuff tear (n ¼ 85), rotator cuff arthropathy (RCA) (n ¼ 184), and proximal humerus fracture (n ¼ 69). Opioid consumption within 90 days surrounding surgery was recorded from Prescription Drug Monitoring Programs. Logistic regression was performed. Results: Baseline characteristics for sex (P ¼ .0001), ethnicity (P ¼ .04), age (P ¼ .01), and preoperative opioid use (P ¼ .029) were significantly different. Patients with osteoarthritis had the lowest preoperative total morphine equivalents (TMEs) at 22.82 compared with fractures (53.36, P ¼ .02) and RCA (46.54, P ¼ .02). There was no significant difference in preoperative opioid dependence based on diagnosis (P ¼ .16); however, postoperatively, the RCA group had the highest dependence at 40.3% (P ¼ .03). In addition, there were no significant differences postoperatively in TMEs prescribed (P ¼ .197). The preoperatively dependent patients were 8 times more likely to remain dependent regardless of diagnosis. Conclusion: Patients with fractures consume the highest amounts of opioids surrounding surgery. Surgeons should tailor their preoperative education and pain management protocols accordingly based on diagnoses for RSA. In addition, increased awareness and protocols need to be implemented for preoperative opioid-dependent patients regardless of diagnosis.

Patients Use Fewer Opioids Than Prescribed After Arthroscopic Release of Elbow Contracture: An Evidence-Based Opioid Prescribing Guideline to Reduce Excess

“…The majority of studies in opioid consumption in the shoulder and elbow literature address opioid usage after shoulder procedures, primarily shoulder arthroplasty and rotator cuff repair. [16][17][18][19][20][21][22] One previous study examined risk factors for chronic opioid use after elbow arthroscopy. 23 In this study, Rojas et al using data from a national database found that preoperative opioid filling, fibromyalgia, and psychiatric illness were associated with an increased risk of prolonged postoperative opioid use after elbow arthroscopy, whereas patients <40 years of age and chronic obstructive pulmonary disease were associated with a decreased risk.…”

“…The majority of studies in opioid consumption in the shoulder and elbow literature address opioid usage after shoulder procedures, primarily shoulder arthroplasty and rotator cuff repair. 16 , 17 , 18 , 19 , 20 , 21 , 22 One previous study examined risk factors for chronic opioid use after elbow arthroscopy. 23 In this study, Rojas et al.…”

Application of risk assessment tools to predict opioid usage after shoulder surgery

“… 18 , 32 , 45 , 52 , 61 In the present literature, considerable evidence suggests that preoperative opioid consumption, abuse, or dependence is predictive of increased opioid consumption, prolonged use, and dependence perioperatively and postoperatively ( Table I ). 4 , 13 , 14 , 19 , 39 , 41 , 42 , 43 , 47 , 50 , 52 , 56 , 68 Preoperative opioid use has also been linked to worse clinical outcomes and lower rates of patient satisfaction. 12 , 49 , 63 Sabesan et al found that, compared to other pathologies, use of a reverse shoulder arthroplasty after a proximal humerus fracture was associated with an increased postoperative opioid dependence, and Jildeh et al found specific surgical factors including presence of biceps tenodesis and number of concomitant procedures significantly increased postoperative opioid demand.…”

“… 12 , 49 , 63 Sabesan et al found that, compared to other pathologies, use of a reverse shoulder arthroplasty after a proximal humerus fracture was associated with an increased postoperative opioid dependence, and Jildeh et al found specific surgical factors including presence of biceps tenodesis and number of concomitant procedures significantly increased postoperative opioid demand. 39 , 56 Additionally, social and medical history factors including current smoking status, income bracket, young age, history of psychiatric and mood disorders, fibromyalgia, and low back pain have been found to contribute to increased risk. 6 , 18 , 32 , 42 , 43 , 45 , 61 , 66 , 68 Despite significant interest and investigation into individual factors to predict chronic opioid use and dependence, there is a paucity of data in the orthopedic literature on simple, effective screening tools for shoulder surgery patients that are easily implemented in the clinical environment.…”

“… Okoroha et al, 2019 50 Pain after anatomic total shoulder arthroplasty vs. reverse total shoulder arthroplasty Prospective cohort Total shoulder arthroplasty Reverse total shoulder arthroplasty Patients with preoperative opioid use were more likely to continue to require opioids postoperatively. Sabesan et al, 2019 56 Diagnosis can predict opioid usage and dependence in reverse shoulder arthroplasty Retrospective chart review Total shoulder arthroplasty Preoperative opioid-dependent patients had 8× higher risk to remain dependent after surgery. Westermann et al, 2017 68 Opioid consumption after rotator cuff repair Retrospective chart review Shoulder arthroscopy Patients with psychiatric conditions, lower back pain, myalgia, and preoperative opioid use have increased risk of postoperative opioid use.…”