Opioid use following shoulder stabilization surgery: risk factors for prolonged use

Khazi, Zain; Lu, Yining; Shamrock, Alan G.; Duchman, Kyle R.; Westermann, Robert W.; Wolf, Brian R.

doi:10.1016/j.jse.2019.05.026

Cited by 16 publications

(16 citation statements)

References 33 publications

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“…7 Similar to our methodology, previous studies have extracted data from the Humana database to identify the trends in perioperative opioid prescription in patients undergoing shoulder procedures and to explore the risk factors for increased postoperative opioid demand. 22,25,40 These factors include a history of alcohol abuse, psychiatric disorders, female sex, and higher index of comorbidity, among others. While Leroux et al 25 and Khazi et al 22 studied patients who underwent open and arthroscopic shoulder surgery, Westermann et al 40 focused on patients who underwent arthroscopic rotator cuff repair, and we compared the trends of opioid prescription filling among 4 common arthroscopic shoulder procedures (labral repair, subacromial decompression, rotator cuff repair, and diagnostic arthroscopy).…”

Section: Discussionmentioning

confidence: 99%

“…22,25,40 These factors include a history of alcohol abuse, psychiatric disorders, female sex, and higher index of comorbidity, among others. While Leroux et al 25 and Khazi et al 22 studied patients who underwent open and arthroscopic shoulder surgery, Westermann et al 40 focused on patients who underwent arthroscopic rotator cuff repair, and we compared the trends of opioid prescription filling among 4 common arthroscopic shoulder procedures (labral repair, subacromial decompression, rotator cuff repair, and diagnostic arthroscopy). We found that patients who had filled ≥1 opioid prescriptions within the 3 months before surgery were more likely to fill an opioid prescription at the time of surgery and 2 weeks postoperatively as compared with patients without preoperative opioid prescription filling.…”

Section: Discussionmentioning

confidence: 99%

“…6,8,11,[13][14][15] Another reported advantage of performing a nerve block in these patients is the reduction in the amount of opioid analgesics consumed following the procedure, which reduces the risk of potential opioid recreational use or abuse. 1,2,22,24,25,33,36 Previous studies have reported the trends of postoperative opioid prescription filling after shoulder arthroscopy and other orthopaedic procedures, using data from national registries. § Factors that have been identified to increase the risk of prolonged opioid use (>180 days) following shoulder arthroscopy include preoperative opioid use, rotator cuff surgery, alcohol abuse, psychiatric disorders, female sex, higher Charlson Comorbidity index, obesity, and tobacco use.…”

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confidence: 99%

“…6,8,11,13 –15 Another reported advantage of performing a nerve block in these patients is the reduction in the amount of opioid analgesics consumed following the procedure, which reduces the risk of potential opioid recreational use or abuse. 1,2,22,24,25,33,36…”

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confidence: 99%

“…§ Factors that have been identified to increase the risk of prolonged opioid use (>180 days) following shoulder arthroscopy include preoperative opioid use, rotator cuff surgery, alcohol abuse, psychiatric disorders, female sex, higher Charlson Comorbidity index, obesity, and tobacco use. 22,25 There is a paucity of large studies examining trends in regional anesthesia for shoulder arthroscopy. In addition, none of the large database studies cited has examined the procedure-specific opioid trends in patients undergoing shoulder arthroscopy who received a regional nerve block versus those who did not.…”

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confidence: 99%

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National Trends in Use of Regional Anesthesia and Postoperative Patterns of Opioid Prescription Filling in Shoulder Arthroscopy: A Procedure-Specific Analysis in Patients With or Without Recent Opioid Exposure

Trasolini

Bolia

Kang

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: There are few large database studies on national trends in regional anesthesia for various arthroscopic shoulder procedures and the effect of nerve blocks on the postoperative rate of opioid prescription filling. Hypothesis: The use of regional nerve block will decrease the rate of opioid prescription filling after various shoulder arthroscopic procedures. Also, the postoperative pattern of opioid prescription filling will be affected by the preoperative opioid prescription-filling history. Study Design: Cohort study; Level of evidence, 3. Methods: Patient data from Humana, a large national private insurer, were queried via PearlDiver software, and a retrospective review was conducted from 2007 through 2015. Patients undergoing arthroscopic shoulder procedures were identified through Current Procedural Terminology codes. Nerve blocks were identified by relevant codes for single-shot and indwelling catheter blocks. The blocked and unblocked cases were age and sex matched to compare the pain medication prescription-filling pattern. Postoperative opioid trends (up to 6 months) were compared by regression analysis. Results: We identified 82,561 cases, of which 54,578 (66.1%) included a peripheral nerve block. Of the patients who received a block, 508 underwent diagnostic shoulder arthroscopy; 2449 had labral repair; 4746 had subacromial decompression procedure; and 12,616 underwent rotator cuff repair. The percentage of patients undergoing a nerve block increased linearly over the 9-year study period ( R 2 = 0.77; P = .002). After matching across the 2 cohorts, there was an identical trend in opioid prescription filling between blocked and unblocked cases ( P = .95). When subdivided by procedure, there was no difference in the trends between blocked and unblocked cases ( P = .52 for diagnostic arthroscopies; P = .24 for labral procedures; P = .71 for subacromial decompressions; P = .34 for rotator cuff repairs). However, when preoperative opioid users were isolated, postoperative opioid prescription filling was found to be less common in the first 2 weeks after surgery when a nerve block was given versus not given ( P < .001). Conclusion: An increasing percentage of shoulder arthroscopies are being performed with regional nerve blocks. However, there was no difference in patterns of filled postoperative opioid prescriptions between blocked and unblocked cases, except for the subgroup of patients who had filled an opioid prescription within 1 to 3 months prior to shoulder arthroscopy. Future research should focus on recording the amount of prescribed opioids consumed in national databases to reinforce our strategy against the opioid epidemic.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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confidence: 99%

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National Trends in Use of Regional Anesthesia and Postoperative Patterns of Opioid Prescription Filling in Shoulder Arthroscopy: A Procedure-Specific Analysis in Patients With or Without Recent Opioid Exposure

Trasolini

Bolia

Kang

et al. 2020

Orthopaedic Journal of Sports Medicine

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Machine-learning model successfully predicts patients at risk for prolonged postoperative opioid use following elective knee arthroscopy

Forlenza

Wilbur

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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PurposeRecovery following elective knee arthroscopy can be compromised by prolonged postoperative opioid utilization, yet an effective and validated risk calculator for this outcome remains elusive. The purpose of this study is to develop and validate a machine‐learning algorithm that can reliably and effectively predict prolonged opioid consumption in patients following elective knee arthroscopy. MethodsA retrospective review of an institutional outcome database was performed at a tertiary academic medical centre to identify adult patients who underwent knee arthroscopy between 2016 and 2018. Extended postoperative opioid consumption was defined as opioid consumption at least 150 days following surgery. Five machine‐learning algorithms were assessed for the ability to predict this outcome. Performances of the algorithms were assessed through discrimination, calibration, and decision curve analysis. ResultsOverall, of the 381 patients included, 60 (20.3%) demonstrated sustained postoperative opioid consumption. The factors determined for prediction of prolonged postoperative opioid prescriptions were reduced preoperative scores on the following patient‐reported outcomes: the IKDC, KOOS ADL, VR12 MCS, KOOS pain, and KOOS Sport and Activities. The ensemble model achieved the best performance based on discrimination (AUC = 0.74), calibration, and decision curve analysis. This model was integrated into a web‐based open‐access application able to provide both predictions and explanations. ConclusionFollowing appropriate external validation, the algorithm developed presently could augment timely identification of patients who are at risk of extended opioid use. Reduced scores on preoperative patient‐reported outcomes, symptom duration and perioperative oral morphine equivalents were identified as novel predictors of prolonged postoperative opioid use. The predictive model can be easily deployed in the clinical setting to identify at risk patients thus allowing providers to optimize modifiable risk factors and appropriately counsel patients preoperatively. Level of evidenceIII.

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Preoperative Opioid Usage, Male Sex, and Preexisting Knee Osteoarthritis Impacts Opioid Refills After Isolated Arthroscopic Meniscectomy: A Population-Based Study

Khazi

Baron

Shamrock

et al. 2020

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Opioid use following shoulder stabilization surgery: risk factors for prolonged use

Cited by 16 publications

References 33 publications

National Trends in Use of Regional Anesthesia and Postoperative Patterns of Opioid Prescription Filling in Shoulder Arthroscopy: A Procedure-Specific Analysis in Patients With or Without Recent Opioid Exposure

National Trends in Use of Regional Anesthesia and Postoperative Patterns of Opioid Prescription Filling in Shoulder Arthroscopy: A Procedure-Specific Analysis in Patients With or Without Recent Opioid Exposure

Machine-learning model successfully predicts patients at risk for prolonged postoperative opioid use following elective knee arthroscopy

Preoperative Opioid Usage, Male Sex, and Preexisting Knee Osteoarthritis Impacts Opioid Refills After Isolated Arthroscopic Meniscectomy: A Population-Based Study

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