دورية أكاديمية
Surgeon Prescribing Patterns And Perioperative Risk Factors Associated With Prolonged Opioid Use After Total Shoulder Arthroplasty.
| العنوان: | Surgeon Prescribing Patterns And Perioperative Risk Factors Associated With Prolonged Opioid Use After Total Shoulder Arthroplasty. |
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| المؤلفون: | Pezzulo JD; From the Thomas Jefferson University School of Medicine, Philadelphia, PA (Pezzulo, Farronato, and Juniewicz), and The Rothman Institute at Thomas Jefferson University, Philadelphia, PA (Kane, Kellish, and Davis)., Farronato DM, Juniewicz R, Kane LT, Kellish AS, Davis DE |
| المصدر: | The Journal of the American Academy of Orthopaedic Surgeons [J Am Acad Orthop Surg] 2024 Aug 23. Date of Electronic Publication: 2024 Aug 23. |
| Publication Model: | Ahead of Print |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Wolters Kluwer Country of Publication: United States NLM ID: 9417468 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1940-5480 (Electronic) Linking ISSN: 1067151X NLM ISO Abbreviation: J Am Acad Orthop Surg Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: 2016- : Philadelphia : Wolters Kluwer Original Publication: Rosemont, IL : American Academy of Orthopaedic Surgeons, c1993- |
| مستخلص: | Introduction: The opioid epidemic in the United States has contributed to a notable economic burden and increased mortality. Total shoulder arthroplasty (TSA) has become more prevalent, and opioids are commonly used for postoperative pain management. Prolonged opioid use has been associated with adverse outcomes, but the role of surgeons in this context remains unclear. This study aims to investigate the incidence and risk factors of prolonged opioid utilization after primary TSA. Methods: After obtaining institutional review board approval, a retrospective review of 4,488 primary total shoulder arthroplasties from 2014 to 2022 at a single academic institution was conducted. Patients were stratified by preoperative and postoperative opioid use, and demographic, clinical, and prescription data were collected. Prescriptions filled beyond 30 days after the index operation were considered prolonged use. Multivariate analysis was conducted to determine the independent risk factors associated with prolonged opioid utilization. Results: Among 4,488 patients undergoing primary TSA, 22% of patients developed prolonged opioid use with 70% of prolonged users being opioid-exposed preoperatively. Independent risk factors of prolonged use include patient age younger than 65 years (Odds Ratio (OR) 1.02, P < 0.001), female sex (OR 1.41, P < 0.001), race other than Caucasian (OR 1.36, P = 0.003), undergoing reverse TSA (OR 1.28, P = 0.010), residing in an urban community (OR 1.33, P = 0.039), preoperative opioid utilization (OR 6.41, P < 0.001), preoperative benzodiazepine utilization (OR 1.93, P < 0.001), and increased postoperative day 1-30 milligram morphine equivalent (OR 1.003, P < 0.001). Discussion: Nearly 22% of patients experienced prolonged opioid use, with preoperative opioid exposure being the most notable risk factor in addition to postoperative prescribing patterns and benzodiazepine utilization. Surgeons play a crucial role in opioid management, and understanding the risk factors can help optimize benefits while minimizing the associated risks of prolonged opioid use. Additional research is needed to establish standardized definitions and strategies for safe opioid use in orthopaedic surgery. (Copyright © 2024 by the American Academy of Orthopaedic Surgeons.) |
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| تواريخ الأحداث: | Date Created: 20240828 Latest Revision: 20240828 |
| رمز التحديث: | 20240830 |
| DOI: | 10.5435/JAAOS-D-24-00051 |
| PMID: | 39197075 |
| قاعدة البيانات: | MEDLINE |
Full Text Finder | تدمد: | 1940-5480 |
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| DOI: | 10.5435/JAAOS-D-24-00051 |