Risk factors for postoperative opioid use after elective shoulder arthroplasty
Section snippets
Study design, setting, and study sample
We conducted a cohort study using our integrated health care system's Shoulder Arthroplasty Registry (SAR).12 The integrated health care system covers more than 11.7 million lives throughout 8 geographic regions (ie, Colorado, Georgia, Hawaii, Mid-Atlantic, Northern California, Northwest, Southern California, and Washington) in the US.24
The study sample was selected using the SAR and consisted of all elective primary SA procedures for nonfracture indications performed in Hawaii, Northern
Results
The final study sample consisted of 4243 SAs performed in 3996 patients. Procedures were performed at 37 health care centers in 3 regions by 177 surgeons. Of these SA patients, 84.1% (n = 3570) were aged ≥60 years, 51.9% (n = 2201) were women, 80.5% (n = 3406) were white, 57.0% (n = 2176) had a BMI <30 kg/m2, and 45.6% (n = 1773) had an ASA classification >II. During the 1-year preoperative period, 75% of SA patients used opioids (range, 1-79 Rxs). Postoperatively, 92.6% used opioids in the
Discussion
Prior studies have identified the untoward effects of preoperative opioid use on postoperative opioid demand and outcomes in multiple orthopedic patient populations.10, 29, 30, 40, 43, 44 This study confirms previous SA literature demonstrating a significant level of preoperative opioid usage in patients undergoing SA.10, 29, 30 We found the prevalence of preoperative opioid use in patients undergoing SA was 75% the year before surgery. Opioid use diminishes in time after SA but remained at 39%
Conclusion
Preoperative opioid usage in patients undergoing SA was widespread, with three-fourths of patients having at least 1 Rx dispensed in the 1-year preoperative period. We found certain patient characteristics, comorbidities, and surgical types were associated with opioid use after SA. These findings can help surgeons identify those most at risk for prolonged opioid use. It will be important to minimize preoperative opioid use, which surgeons and physicians may have greater ability to control
Disclaimer
The authors, their immediate families, and any research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.
Acknowledgment
The authors acknowledge the Kaiser Permanente orthopedic surgeons who contribute to the Kaiser Permanente SAR and the Surgical Outcomes and Analysis Department staff, which coordinates registry operations. The authors also acknowledge William E. Burfeind, BS, for his ongoing support of the Kaiser Permanente SAR database and quality control management.
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2022, Orthopaedics and Traumatology: Surgery and ResearchCitation Excerpt :Reported risk factors for acute inpatient opioid utilization in ankle surgery patients include anesthetic choice and a patient's socioeconomic background [27]. In TSA, Rao et al. found that while certain medical conditions like anemia, liver disease, arthritis, and peripheral vascular disease were associated with increased opioid use in the early postoperative period, no comorbidities were associated with increased opioid use in the 1-year postoperative period [28]. Regarding readmission rates, Merrill et al.’s analysis of arthrodesis surgeries queried from the National Readmission Database did not find that any comorbidities conferred an increased risk for 30-day readmission [29].
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The Kaiser Permanente Southern California Institutional Review Board approved this study (#5527).