Preoperative Narcotic Use and Inferior Outcomes After Anatomic Total Shoulder Arthroplasty: A Clinical and Radiographic Analysis

Thompson, Kirk M.; Hallock, Justin D.; Smith, Richard A.; Brolin, Tyler J.; Azar, Frederick M.; Throckmorton, Thomas W.

doi:10.5435/jaaos-d-16-00808

Cited by 32 publications

(38 citation statements)

References 24 publications

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“…Thompson et al 28 also found significant improvements in ROM for the opioid group (internal rotation, P ¼ .001; external rotation, P ¼ .004; forward flexion, P ¼ .001) and the nonopioid group (internal rotation, P ¼ .002; external rotation, P ¼ .001; forward flexion, P ¼ .001) from the preto postoperative period.…”

Section: Range Of Motionmentioning

confidence: 88%

“…Williams et al 32 and Morris et al 18 found significantly higher frequencies of back pain (P ¼ .007 and P ¼ .004, respectively) and depression (P < .04 and P ¼ .04) in the opioid group versus the nonopioid group. However, 3 of these studies 17,18,28 showed no statistically significant differences between groups in regard to age, sex, follow-up duration, smoking, diabetes, and heart disease.…”

Section: Patient Demographicsmentioning

confidence: 89%

“…Thompson et al 28 found that the opioid user group had significantly worse median VAS scores preoperatively (P ¼ .02) and postoperatively (P ¼ .001) as compared with the nonopioid users. Similarly, Williams et al 32 found a trend toward higher VAS scores at pre-and postoperative time points in the opioid user group; however, these differences were not statistically significant (P ¼ .3).…”

Section: Pain Scoresmentioning

confidence: 98%

“…All followed standard surgical techniques and postoperative rehabilitation protocols. 8,9,14 Thompson et al 28 noted that the surgical procedures were performed with the patient in the beach-chair position with a deltopectoral approach and that muscular paralysis was used. The subscapularis was managed with tenotomy and transosseous repair.…”

Section: Total Shoulder Arthroplastymentioning

confidence: 99%

“…ASES values from Cheah et al 5 were pooled from 59 patients who were followed up for at least 2 years postoperatively. Thompson et al 28 conducted the only study to note a significant difference (P ¼ .01) in overall improvement of median ASES scores, showing that the opioid group had significantly inferior results than the nonopioid group. Furthermore, all 3 studies 17,18,32 that included CMS outcomes and the 2 studies 17,18 with WOOS indices found no significant differences in overall improvement between groups.…”

Section: Functional Scoresmentioning

confidence: 99%

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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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Section: Range Of Motionmentioning

confidence: 88%

Section: Patient Demographicsmentioning

confidence: 89%

Section: Pain Scoresmentioning

confidence: 98%

Section: Total Shoulder Arthroplastymentioning

confidence: 99%

Section: Functional Scoresmentioning

confidence: 99%

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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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What are the common factors that lead to the failure to achieve minimal clinically important difference after shoulder surgery? A scoping review

Kerhoulas,

Ojaghi,

Hayes

et al. 2024

Eur J Orthop Surg Traumatol

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Prevalence of Prescription Opioids for Nonoperative Treatment of Rotator Cuff Disease Is High

Gorbaty

Odum

Wally

et al. 2021

Arthroscopy, Sports Medicine, and Rehabilitation

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To quantify the prevalence of opioid and benzodiazepine prescriptions for patients with rotator cuff disease across a large health care system and to describe evidence-based risk factors for opioid use within this population. Methods: We conducted a retrospective cohort study at a major health care system of all patients with qualifying diagnostic codes. Emergency department, urgent care, and outpatient encounters between January and December 2016 for an acute rotator cuff tear, listed as the primary diagnosis, were included. Encounters with prescriptions for opioids or benzodiazepines were identified using the Prescription Reporting With Immediate Medication Utilization Mapping (PRIMUM) system. Descriptive statistics and the rate of controlled-substance prescribing were calculated for the population as a whole and among subgroups. Results: We identified 9,376 encounters meeting the inclusion criteria. Of these encounters, 1,559 (16.6%) resulted in 1 or more prescriptions for an opioid or benzodiazepine that were issued during the visit. A total of 2,007 opioid and/or benzodiazepine prescriptions were issued for the 1,559 encounters (rate of 1.29 prescriptions per prescribing encounter). This represented 5,310 patients, of whom 1,096 (20.6%) received a prescription for an opioid or benzodiazepine during at least 1 of their encounters. Of patients who received a prescription, 20.9% had at least 1 risk factor for prescription misuse; 3.6% of patients had more than 1 risk factor. There were no demographic differences between patients with risk factors and patients without them. Conclusions: The prescribing of opioids for the treatment of pain in patients with rotator cuff disease remains high across multiple locations and specialties within a large health care system. Using alternative pain management pathways as primary prevention for opioid misuse and abuse in high opioid-prescribing locationsdand especially for patients identified as having a high risk of opioid misusedis an important practice to continue in our shift away from opioid use as a health care system. Level of Evidence: Level IV, case series.

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Preoperative Narcotic Use and Inferior Outcomes After Anatomic Total Shoulder Arthroplasty: A Clinical and Radiographic Analysis

Abstract: Chronic preoperative narcotic use seems to be a notable indicator of poor outcomes of anatomic total shoulder arthroplasty for glenohumeral osteoarthritis.

Cited by 32 publications

References 24 publications

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

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

What are the common factors that lead to the failure to achieve minimal clinically important difference after shoulder surgery? A scoping review

Prevalence of Prescription Opioids for Nonoperative Treatment of Rotator Cuff Disease Is High

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