Presurgical and Postsurgical Opioid Rates in Patients Undergoing Total Shoulder Replacement Surgery.

Area of Science:

• Orthopedic Surgery
• Pain Management
• Public Health

Background:

• Opioid prescription patterns before and after total shoulder replacement (TSR) are not well-defined.
• Understanding these patterns is crucial for managing post-operative pain and mitigating opioid-related risks.

Purpose of the Study:

• To describe pre- and postsurgical opioid prescription rates.
• To determine average morphine milligram equivalents (MME) per day in patients undergoing TSR.

Main Methods:

• Retrospective analysis of electronic health records for 1,076 patients undergoing TSR.
• Recorded opioid prescriptions 12 months pre- and post-surgery.
• Statistical analysis including McNemar tests, Wilcoxon signed rank test, and logistic regression.

Main Results:

• Significant increase in opioid prescription rates from pre- to post-surgery (p=0.0015).
• Patients with no pre-surgical opioid use were 4.6 times more likely to receive post-surgical opioids (p < .0001).
• Most post-surgical opioid prescriptions were low dosage (<50 MME/day), with >82% of patients at low overdose risk.

Conclusions:

• While non-opioid users are more likely to receive post-surgical opioids, dosages indicate low overdose risk per CDC guidelines.
• Comorbidities and lack of pre-surgical alcohol use were associated with higher likelihood of post-surgical opioid prescription.