Surgeon Prescribing Patterns And Perioperative Risk Factors Associated With Prolonged Opioid Use After Total Shoulder...

Area of Science:

• Orthopaedic Surgery
• Pain Management
• Public Health

Background:

• The opioid epidemic presents significant economic and mortality challenges in the US.
• Opioids are commonly used for pain management after total shoulder arthroplasty (TSA).
• Understanding prolonged opioid use after TSA is crucial for mitigating adverse outcomes.

Purpose of the Study:

• To investigate the incidence of prolonged opioid use after primary TSA.
• To identify independent risk factors associated with prolonged opioid utilization in TSA patients.

Main Methods:

• Retrospective review of 4,488 primary TSA cases from 2014-2022.
• Stratification based on preoperative and postoperative opioid use.
• Multivariate analysis to determine risk factors for prolonged opioid use (defined as >30 days post-op).

Main Results:

• 22% of patients developed prolonged opioid use post-TSA.
• Preoperative opioid exposure (OR 6.41) was the strongest risk factor.
• Other significant factors included younger age, female sex, non-Caucasian race, reverse TSA, urban residence, and benzodiazepine use.

Conclusions:

• Preoperative opioid exposure is a primary driver of prolonged use after TSA.
• Postoperative prescribing and benzodiazepine use also contribute significantly.
• Surgeons must optimize opioid management strategies to minimize risks associated with prolonged use.