Risk Factors for Preoperative Opioid Use in Patients Undergoing Primary Anatomic Total Shoulder Arthroplasty
Abstract
The effect of preoperative opioid use in orthopedic patients has been highlighted. Numerous studies have identified worse patient outcomes with pre-operative opioid use; however, there is currently no information identifying risk factors for preoperative opioid use in the total shoulder arthroplasty (TSA) population. The purpose of this study was to determine risk factors for preoperative opioid use in patients undergoing primary anatomic TSA for primary osteoarthritis (OA) and to determine baseline preoperative patient-reported outcomes (PROs) in preoperative opioid users compared with nonopioid users. The authors studied 982 TSAs performed for primary glenohumeral joint OA in a prospective TSA registry. Patient demographic and clinical characteristics were prospectively assessed and included age; sex; socioeconomic status (SES); smoking status; body mass index (BMI); and history of chronic back pain, depression, diabetes mellitus, and heart disease. Preoperative PROs, range of motion measurements, and preoperative opioid use for shoulder pain were assessed. Overall, 254 (25.9%) of 982 total patients were taking preoperative opioids for shoulder pain in the setting of primary OA. Female sex (P=.023), younger age (P=.019), obesity (BMI >30 kg/m2) (P=.043), chronic back pain (P<.001), and lower SES (P=.002) were associated with increased preoperative opioid use following multivariate logistic regression. Patients with opioid use had significantly worse preoperative pain scores (P<.001), American Shoulder and Elbow Surgeons scores (P<.001), and total Constant scores (P<.002) compared with the non-opioid group. [Orthopedics. 2020;43(6):356–360.]
- 1.Morris BJ, Mir HR. The opioid epidemic: impact on orthopaedic surgery. J Am Acad Orthop Surg. 2015; 23(5):267–271.
10.5435/JAAOS-D-14-00163 PMID:25911660 Crossref Medline, Google Scholar - 2.Morris BJ, Zumsteg JW, Archer KR, Cash B, Mir HR. Narcotic use and postoperative doctor shopping in the orthopaedic trauma population. J Bone Joint Surg Am. 2014; 96(15):1257–1262.
10.2106/JBJS.M.01114 PMID:25100772 Crossref Medline, Google Scholar - 3.Morris BJ, Sciascia AD, Jacobs CA, Edwards TB. Preoperative opioid use associated with worse outcomes after anatomic shoulder arthroplasty. J Shoulder Elbow Surg. 2016; 25(4):619–623.
10.1016/j.jse.2015.09.017 PMID:26652698 Crossref Medline, Google Scholar - 4.Morris BJ, Laughlin MS, Elkousy HA, Gartsman GM, Edwards TB. Preoperative opioid use and outcomes after reverse shoulder arthroplasty. J Shoulder Elbow Surg. 2015; 24(1):11–16.
10.1016/j.jse.2014.05.002 PMID:25037063 Crossref Medline, Google Scholar - 5.Williams BT, Redlich NJ, Mickschl DJ, Grindel SI. Influence of preoperative opioid use on postoperative outcomes and opioid use after arthroscopic rotator cuff repair. J. Shoulder Elbow Surg.2019; 28(3):453–460.
10.1016/j.jse.2018.08.036 . Crossref Medline, Google Scholar - 6.Fisher DA, Dierckman B, Watts MR, Davis K. Looks good but feels bad: factors that contribute to poor results after total knee arthroplasty. J Arthroplasty. 2007; 22(6)(suppl 2):39–42.
10.1016/j.arth.2007.04.011 PMID:17823013 Crossref Medline, Google Scholar - 7.Lee D, Armaghani S, Archer KR, Preoperative opioid use as a predictor of adverse postoperative self-reported outcomes in patients undergoing spine surgery. J Bone Joint Surg Am. 2014; 96(11):e89.
10.2106/JBJS.M.00865 PMID:24897746 Crossref Medline, Google Scholar - 8.Zywiel MG, Stroh DA, Lee SY, Bonutti PM, Mont MA. Chronic opioid use prior to total knee arthroplasty. J Bone Joint Surg Am. 2011; 93(21):1988–1993.
10.2106/JBJS.J.01473 PMID:22048093 Crossref Medline, Google Scholar - 9.Lindenhovius ALC, Helmerhorst GT, Schnellen AC, Vrahas M, Ring D, Kloen P. Differences in prescription of narcotic pain medication after operative treatment of hip and ankle fractures in the United States and The Netherlands. J Trauma. 2009; 67(1):160–164.
10.1097/TA.0b013e31818c12ee PMID:19590328 Crossref Medline, Google Scholar - 10.Michener LA, McClure PW, Sennett BJ. American shoulder and elbow surgeons standardized shoulder assessment form, patient self-report section: reliability, validity, and responsiveness. J Shoulder Elbow Surg. 2002; 11(6):587–594.
10.1067/mse.2002.127096 PMID:12469084 Crossref Medline, Google Scholar - 11.Constant CR, Gerber C, Emery RJH, Søjbjerg JO, Gohlke F, Boileau P. A review of the Constant score: modifications and guidelines for its use. J Shoulder Elbow Surg. 2008; 17(2):355–361.
10.1016/j.jse.2007.06.022 PMID:18218327 Crossref Medline, Google Scholar - 12.Williams GN, Gangel TJ, Arciero RA, Uhorchak JM, Taylor DC. Comparison of the single assessment numeric evaluation method and two shoulder rating scales: outcomes measures after shoulder surgery. Am J Sports Med. 1999; 27(2):214–221.
10.1177/03635465990270021701 PMID:10102104 Crossref Medline, Google Scholar - 13.University of Wisconsin School of Medicine Public Health. 2015 Area Deprivation Index v2.0. https://www.neighborhoodatlas.medicine.wisc.edu. Accessed February 19, 2019. Google Scholar
- 14.Edwards TB, Morris BJ. Shoulder Arthroplasty, 2nd ed. Philadelphia, PA: Elsevier; 2018. Google Scholar
- 15.Hilliard PE, Waljee J, Moser S, Prevalence of preoperative opioid use and characteristics associated with opioid use among patients presenting for surgery. JAMA Surg. 2018; 153(10):929–937.
10.1001/jamasurg.2018.2102 PMID:29998303 Crossref Medline, Google Scholar - 16.Kidner CL, Mayer TG, Gatchel RJ. Higher opioid doses predict poorer functional outcome in patients with chronic disabling occupational musculoskeletal disorders. J Bone Joint Surg Am. 2009; 91(4):919–927.
10.2106/JBJS.H.00286 PMID:19339577 Crossref Medline, Google Scholar - 17.Manchikanti L, Helm S, Fellows B, Opioid epidemic in the United States. Pain Physician. 2012; 15(3)(suppl):ES9–ES38. PMID:
22786464 Crossref Medline, Google Scholar
