High pain intensity after total shoulder arthroplasty

Area of Science:

• Orthopedic Surgery
• Pain Management
• Health Economics

Background:

• Growing emphasis on quality and patient experience in healthcare reimbursement.
• Need for effective postoperative pain management alongside responsible opioid use.
• Interest in understanding factors influencing severe pain after total shoulder arthroplasty.

Purpose of the Study:

• To identify predictors of severe inpatient pain following elective total shoulder arthroplasty.
• To assess the association between severe pain and opioid consumption, length of stay, discharge disposition, and cost.

Main Methods:

• Analysis of 415 patients undergoing elective primary total shoulder arthroplasty (2016-2017).
• Definition of severe postoperative pain as peak pain intensity ≥75th percentile.
• Multivariable logistic regression to identify preoperative predictors (demographics, emotional health, comorbidities, ASES score).
• Quantification of opioid consumption (oral morphine equivalents) and cost (time-driven activity-based costing).

Main Results:

• Key predictors of severe pain: increased allergies, preoperative chronic opioid use, lower American Shoulder and Elbow Surgeons (ASES) score, and depression.
• Severe pain associated with higher opioid use (202 vs. 84 mg OMEs), longer hospital stay (2.9 vs. 2.0 days), increased use of inpatient rehabilitation, and higher costs (23% vs. 5%).
• No significant difference in operative time between severe and non-severe pain groups.

Conclusions:

• Psychological and social determinants of health are critical for alleviating pain, reducing opioid use, and controlling costs post-shoulder arthroplasty.
• Findings support redesigning care pathways and bundling initiatives to incorporate these determinants.
• Focusing on non-technical factors may significantly improve outcomes and efficiency in shoulder arthroplasty care.