Preoperative Opioid Use Among Patients Undergoing Shoulder Arthroplasty Predicts Prolonged Postoperative Opioid Use

J Am Acad Orthop Surg. 2018 Aug 1;27(15):e691-e695. doi: 10.5435/JAAOS-D-18-00008.

Abstract

Introduction: This study determines the incidence of opioid use before shoulder arthroplasty and analyzes its influence on postoperative use.

Methods: A retrospective analysis of patients undergoing shoulder arthroplasty with at least 2-year follow-up was performed. Then, at pre- and postoperative appointments, the patients were asked "Do you take narcotic pain medication (codeine or stronger)?"

Results: Among 490 patients included in the study, 35.5% reported preoperative opioid use. These patients had higher incidence of opioid use at 1-year follow-up (29.1% versus 4.9%; odds ratio, 8.320; P < 0.001) and at final follow-up (35.1% versus 7.3%; odds ratio, 6.877; P < 0.001). Opioid usage did not change markedly from 1 year follow-up to final follow-up (P > 0.18).

Discussion: Approximately one-third of patients used opioids preoperatively and were seven times more likely to continue opioid use postoperatively. Opioid usage did not change from 1 year follow-up to final follow-up, suggesting that patients still using opioids at their 1-year appointment were likely to continue opioid use.

Level of evidence: Level III.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Analgesics, Opioid / administration & dosage
  • Analgesics, Opioid / therapeutic use*
  • Arthroplasty, Replacement, Shoulder / adverse effects*
  • Follow-Up Studies
  • Humans
  • Middle Aged
  • Opioid-Related Disorders / complications
  • Opioid-Related Disorders / epidemiology*
  • Pain, Postoperative / drug therapy*
  • Pain, Postoperative / etiology
  • Postoperative Period
  • Preoperative Period
  • Retrospective Studies
  • Time Factors

Substances

  • Analgesics, Opioid