Study of variations in inpatient opioid consumption after total shoulder arthroplasty: influence of patient- and surgeon-related factors

Kolade, Oluwadamilola; Ghosh, Niloy; Fernandez, Laviel; Friedlander, Scott; Zuckerman, Joseph D.; Bosco, Joseph; Virk, Mandeep S.

doi:10.1016/j.jse.2019.06.021

Cited by 14 publications

(15 citation statements)

References 13 publications

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“…Using the Kaiser Permanente shoulder arthroplasty registry, Rao et al 23 found that age less than 60 years, sex, race, body mass index, American Society of Anesthesiologists classification, and preoperative opioid use were patient-based risk factors for increased opioid use within 1 year of shoulder arthroplasty. Kolade et al 17 added that patients with preexisting psychiatric disorders, higher household income, smokers, and recipients of general anesthesia predicted increased inpatient opioid requirements after TSA, but the surgical procedure performed (aTSA vs. rTSA) had no impact on opioid requirements. Another study highlighted that baseline preoperative opioid users had higher inpatient opioid requirements after TSA than nonopioid users; however, opioid prescriptions at discharge were similar between the groups, suggesting that provider preference for standardized discharge protocols still exists despite variations in pain tolerance among different patient populations.…”

Section: Discussionmentioning

confidence: 99%

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The effect of patient factors on opioid use after anatomic and reverse shoulder arthroplasty

Kopechek¹,

Roebke²,

Sridharan³

et al. 2021

JSES International

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Background Prolonged opioid use can lead to suboptimal outcomes after total shoulder arthroplasty (TSA), and thus, reduced consumption is desirable. Our primary aims were to determine if differences in total morphine equivalent doses existed owing to (1) age less than or greater than 65 years, (2) sex, and (3) TSA type – reverse or anatomic total shoulder arthroplasty. We also characterized potential risk factors for (1) visiting another provider for pain, (2) pain control 6 weeks postoperatively, and (3) needing an opioid refill. Methods A retrospective cohort study of 100 patients who underwent TSA (reverse total shoulder arthroplasty N 1 = 50; anatomic total shoulder arthroplasty N 2 = 50) between 1 July 2018 and 31 December 2018 was performed. Demographics, perioperative treatments, and postoperative opioid prescriptions were recorded. Primary hypotheses were evaluated with Wilcoxon-Mann-Whitney testing. Univariate and multivariate analyses assessed potential risk factors for the 3 outcomes of interest. Results were given in adjusted odds ratios (aORs), 95% confidence intervals (CIs), and P values. Results There was a difference ( P = .009) in total morphine equivalent doses used (in 5-milligram oxycodone tablets) between patients who were younger than 65 years of age (median: 83 tablets, interquartile range: 62-140) and those who were older than 65 years of age (median: 65 tablets, interquartile range: 52-90). Unemployment (aOR = 4.68, CI: 1.5-14.2, P = .006) and age less than 65 years (aOR = 4.18, CI: 1.6-11.2, P = .004) were independent risk factors for inadequate pain control 6 weeks postoperatively. Two independent risk factors for needing an opiate prescription refill after discharge were unemployment (aOR = 4.56, CI: 1.5-13.8, P = .007) and preoperative opiate use (aOR = 3.95, CI: 1.4-11.0, P = .009). Conclusion After TSA, morphine equivalent dose usage is higher for patients younger than 65 years of age, and several risk factors exist for requiring a refill and having inadequate pain control 6 weeks postoperatively. Prospective studies using these data to guide interventions may be beneficial.

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Section: Discussionmentioning

confidence: 99%

“…Finally, our finding that no difference in opioid use exists between patients undergoing aTSA and rTSA is consistent with evidence in the literature. 17 , 22 …”

Section: Discussionmentioning

confidence: 99%

The effect of patient factors on opioid use after anatomic and reverse shoulder arthroplasty

Kopechek¹,

Roebke²,

Sridharan³

et al. 2021

JSES International

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“…Although tendon transfer provides an alternative option for younger patients, narrow surgical indications limit its use 8 . Reverse total shoulder arthroplasty is only suitable for elderly patients with severe glenohumeral joint arthritis 9 .…”

Section: Introductionmentioning

confidence: 99%

Arthroscopic Superior Capsule Reconstruction and Rotator Cuff Repair to Restore Static and Dynamic Stability of the Shoulder

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Hou

Tang

et al. 2020

Orthopaedic Surgery

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Objective: Treatment of massive irreparable rotator cuff tears (RCT) has shown limited clinical success and a variety of subsequent complications. Superior capsule reconstruction (SCR) has been proved to reestablish superior stability but does not restore the dynamic force or shoulder kinematics. There are numerous reports of the short-term failure of SCR grafts at the glenoid side, which relate to the non-biological healing of grafts. To restore both dynamic and static stability and to provide biologic augmentation, an integrated procedure for massive irreparable RCT using an Achilles tendon-bone allograft (ATBA) was developed. Method: This was a retrospect study completed between October 2019 and April 2020. A 71-year-old woman with massive and irreparable rotator cuff tears was enrolled in our study. The ATBA was folded into a double-layer structure. The superior layer (proximal portion) served as a bridge patch to dynamic the glenohumeral joint, while the inferior layer (distal portion) served as the superior capsule to restore static stability of glenohumeral joint. To enhance biologic healing on the glenoid side, we fixed the calcaneus of the graft on the superior-posterior side of the superior glenoid rim. The recovery of shoulder function (including strength, range of motion, acromiohumeral interval, and fatty infiltration) was assessed at 6 months postoperation. Result: At 6-month follow-up, the patient's strength had improved significantly (from abduction of grade 3 preoperatively to grade 4 at 6 months). Radiographic analysis showed an increase in the acromiohumeral interval from 3 to 7 mm. Magnetic resonance imaging revealed an intact graft, with the thickness of the ligament part maintained (at 6-7 mm). Most importantly, recovery of atrophy and fatty infiltration of the supraspinatus were observed. No graft tears were observed on the glenoid side. Conclusion: This technique could provide a preferable treatment option by restoring shoulder kinematics and augmentating biological healing for patients with massive irreparable RCT.

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“… 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.…”

mentioning

confidence: 99%

“… 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.…”

mentioning

confidence: 99%

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

Khoury¹,

Stephens²,

Brown³

et al. 2022

JSES International

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Study of variations in inpatient opioid consumption after total shoulder arthroplasty: influence of patient- and surgeon-related factors

Cited by 14 publications

References 13 publications

The effect of patient factors on opioid use after anatomic and reverse shoulder arthroplasty

The effect of patient factors on opioid use after anatomic and reverse shoulder arthroplasty

Arthroscopic Superior Capsule Reconstruction and Rotator Cuff Repair to Restore Static and Dynamic Stability of the Shoulder

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

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