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. |
---|---|
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.) |
References: | CDC: Understanding the Opioid Overdose Epidemic|Opioids|CDC. Centers for Disease Control and Prevention, 2023. Available at: https://www.cdc.gov/opioids/basics/epidemic.html. CDC: Cost of Injury and Violence. Centers for Disease Control and Prevention, 2023, Available at: https://www.cdc.gov/injury/features/health-econ-cost-of-injury/index.html. Florence C, Luo F, Rice K: The economic burden of opioid use disorder and fatal opioid overdose in the United States, 2017. Drug Alcohol Depend 2021;218:108350. Wagner ER, Farley KX, Higgins I, Wilson JM, Daly CA, Gottschalk MB: The incidence of shoulder arthroplasty: Rise and future projections compared with hip and knee arthroplasty. J Shoulder Elbow Surg 2020;29:2601-2609. Chunduri A, Aggarwal AK: Multimodal pain management in orthopedic surgery. J Clin Med 2022;11:6386. Graham JG, Kane LT, Ramtin S, Namdari S. Evidence-based orthopaedic post-operative opioid prescribing recommendations following shoulder surgery. SurgiColl. 2023;1(2). Kurd MF, Kreitz T, Schroeder G, Vaccaro AR: The role of multimodal analgesia in spine surgery. J Am Acad Orthop Surg 2017;25:260-268. Trasolini NA, McKnight BM, Dorr LD: The opioid crisis and the orthopedic surgeon. J Arthroplasty 2018;33:3379-3382.e1. Al-Mohrej OA, Prada C, Madden K, Shanthanna H, Leroux T, Khan M: The role of preoperative opioid use in shoulder surgery—a systematic review. Shoulder Elbow 2023;15:250-273. Cancienne JM, Patel KJ, Browne JA, Werner BC: Narcotic use and total knee arthroplasty. J Arthroplasty 2018;33:113-118. Goplen CM, Verbeek W, Kang SH, et al.: Preoperative opioid use is associated with worse patient outcomes after total joint arthroplasty: A systematic review and meta-analysis. BMC Musculoskelet Disord 2019;20:234. Ravi B, Pincus D, Croxford R, et al.: Patterns of pre-operative opioid use affect the risk for complications after total joint replacement. Sci Rep 2021;11:22124. Best MJ, Harris AB, Bansal A, Huish E, Srikumaran U: Predictors of long-term opioid use after elective primary total shoulder arthroplasty. Orthopedics 2021;44:58-63. Khazi ZM, Lu Y, Patel BH, Cancienne JM, Werner B, Forsythe B: Risk factors for opioid use after total shoulder arthroplasty. J Shoulder Elbow Surg 2020;29:235-243. Kopechek KJ, Roebke AJ, Sridharan M, et al.: The effect of patient factors on opioid use after anatomic and reverse shoulder arthroplasty. JSES Int 2021;5:930-935. Leroux TS, Basques BA, Frank RM, et al.: Outpatient total shoulder arthroplasty: A population-based study comparing adverse event and readmission rates to inpatient total shoulder arthroplasty. J Shoulder Elbow Surg 2016;25:1780-1786. Spencer CC, Pflederer JA, Wilson JM, Dawes AM, Gottschalk MB, Wagner ER: Opioid use following a total shoulder arthroplasty: Who requires refills and for how long?. JSES Int 2021;5:346-352. Townsend CB, Ly JA, Judy R, et al.: Larger perioperative opioid prescriptions lead to prolonged opioid use after hand and upper extremity surgery: A multicenter analysis. J Am Acad Orthop Surg Glob Res Rev 2022;6:e22.00036. Lavoie-Gagne O, Nwachukwu BU, Allen AA, Leroux T, Lu Y, Forsythe B: Factors predictive of prolonged postoperative narcotic usage following orthopaedic surgery. JBJS Rev 2020;8:e0154. Lawal OD, Gold J, Murthy A, et al.: Rate and risk factors associated with prolonged opioid use after surgery: A systematic review and meta-analysis. JAMA Netw Open 2020;3:e207367. Namba RS, Singh A, Paxton EW, Inacio MCS: Patient factors associated with prolonged postoperative opioid use after total knee arthroplasty. J Arthroplasty 2018;33:2449-2454. Basilico M, Bhashyam AR, Harris MB, Heng M: Prescription opioid type and the likelihood of prolonged opioid use after orthopaedic surgery. J Am Acad Orthop Surg 2019;27:e423-e429. Rao AG, Chan PH, Prentice HA, et al.: Risk factors for postoperative opioid use after elective shoulder arthroplasty. J Shoulder Elbow Surg 2018;27:1960-1968. Bakewell BK, Townsend CB, Ly JA, et al.: The effect of preoperative benzodiazepine usage on postoperative opioid consumption after hand surgery: A multicenter analysis. Cureus 2022;14:e29609. Doan LV, Padjen K, Ok D, et al.: Relation between preoperative benzodiazepines and opioids on outcomes after total joint arthroplasty. Sci Rep 2021;11:10528. Hozack BA, Rivlin M, Lutsky KF, et al.: Preoperative exposure to benzodiazepines or sedative/hypnotics increases the risk of greater filled opioid prescriptions after surgery. Clin Orthop Relat Res 2019;477:1482-1488. Bedard NA, DeMik DE, Dowdle SB, Owens JM, Liu SS, Callaghan JJ: Does preoperative opioid use increase the risk of early revision total hip arthroplasty?. J Arthroplasty 2018;33:S154-S156. Bedard NA, Pugely AJ, Dowdle SB, Duchman KR, Glass NA, Callaghan JJ: Opioid use following total hip arthroplasty: Trends and risk factors for prolonged use. J Arthroplasty 2017;32:3675-3679. Hadlandsmyth K, Vander Weg MW, McCoy KD, Mosher HJ, Vaughan-Sarrazin MS, Lund BC: Risk for prolonged opioid use following total knee arthroplasty in veterans. J Arthroplasty 2018;33:119-123. Hsia H-L, Takemoto S, van de Ven T, et al.: Acute pain is associated with chronic opioid use after total knee arthroplasty. Reg Anesth Pain Med 2018;43:705-711. Johnson SP, Chung KC, Zhong L, et al.: Risk of prolonged opioid use among opioid-naïve patients following common hand surgery procedures. J Hand Surg Am 2016;41:947-957.e3. Klein JS, Davis DE, Wells ZS, et al.: The Distress and Risk Assessment Method predicts postoperative narcotic use in patients undergoing rotator cuff repair. J Shoulder Elbow Surg 2019;28:S146-S153. Stepan JG, London DA, Osei DA, Boyer MI, Dardas AZ, Calfee RP: Perioperative celecoxib and postoperative opioid use in hand surgery: A prospective cohort study. J Hand Surg Am 2018;43:346-353. Shah A, Hayes CJ, Martin BC: Characteristics of initial prescription episodes and likelihood of long-term opioid use — United States, 2006-2015. MMWR Morb Mortal Wkly Rep 2017;66:265-269. Cepeda MS, Coplan PM, Kopper NW, Maziere J-Y, Wedin GP, Wallace LE: ER/LA opioid analgesics REMS: Overview of ongoing assessments of its progress and its impact on health outcomes. Pain Med 2017;18:78-85. Willy ME, Graham DJ, Racoosin JA, et al.: Candidate metrics for evaluating the impact of prescriber education on the safe use of extended-release/long-acting (ER/LA) opioid analgesics. Pain Med 2014;15:1558-1568. FDA: Opioid Analgesic Risk Evaluation and Mitigation Strategy (REMS). FDA, 2023. Available at: https://www.fda.gov/drugs/information-drug-class/opioid-analgesic-risk-evaluation-and-mitigation-strategy-rems. Lee S, Kim D-H, Kim SG, Cho C-H: Does reverse shoulder arthroplasty improve emotional status and quality of life in patients with rotator cuff insufficiency? Prospective sequential follow-up study. J Shoulder Elbow Surg 2023;32:1-8. Nolan BM, Ankerson E, Wiater JM: Reverse total shoulder arthroplasty improves function in cuff tear arthropathy. Clin Orthop Relat Res 2011;469:2476-2482. Welch JM, Hurley ET, Lorentz S, et al. Reverse shoulder arthroplasty following failed rotator cuff repair: A systematic review and meta-analysis. Shoulder Elbow. 2023;0(0). |
تواريخ الأحداث: | Date Created: 20240828 Latest Revision: 20240828 |
رمز التحديث: | 20240830 |
DOI: | 10.5435/JAAOS-D-24-00051 |
PMID: | 39197075 |
قاعدة البيانات: | MEDLINE |
تدمد: | 1940-5480 |
---|---|
DOI: | 10.5435/JAAOS-D-24-00051 |