The effect of patient factors on opioid use after anatomic and reverse shoulder arthroplasty
Background: Prolonged opioid use can lead to suboptimal outcomes after total shoulder arthroplasty (TSA), and thus, reduced consumption is desirable. Our primary aims were to determine if differences in total morphine equivalent doses existed owing to (1) age less than or greater than 65 years, (2)...
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doaj-2273004a520b4711bd84126f6c882ae52021-09-01T04:22:53ZengElsevierJSES International2666-63832021-09-0155930935The effect of patient factors on opioid use after anatomic and reverse shoulder arthroplastyKyle J. Kopechek, BS0Austin J. Roebke, MD1Mathangi Sridharan, BS2Richard Samade, MD, PhD3Kanu S. Goyal, MD4Andrew S. Neviaser, MD5Julie Y. Bishop, MD6Gregory L. Cvetanovich, MD7College of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USADepartment of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USACollege of Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USADepartment of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USADepartment of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USADepartment of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USADepartment of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USADepartment of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, OH, USA; Corresponding author: Gregory L. Cvetanovich, MD, Department of Orthopaedics, The Jameson Crane Sports Institute of The Ohio State University Wexner Medical Center, 2835 Fred Taylor Drive Columbus, OH 43202, USA.Background: Prolonged opioid use can lead to suboptimal outcomes after total shoulder arthroplasty (TSA), and thus, reduced consumption is desirable. Our primary aims were to determine if differences in total morphine equivalent doses existed owing to (1) age less than or greater than 65 years, (2) sex, and (3) TSA type – reverse or anatomic total shoulder arthroplasty. We also characterized potential risk factors for (1) visiting another provider for pain, (2) pain control 6 weeks postoperatively, and (3) needing an opioid refill. Methods: A retrospective cohort study of 100 patients who underwent TSA (reverse total shoulder arthroplasty N1 = 50; anatomic total shoulder arthroplasty N2 = 50) between 1 July 2018 and 31 December 2018 was performed. Demographics, perioperative treatments, and postoperative opioid prescriptions were recorded. Primary hypotheses were evaluated with Wilcoxon-Mann-Whitney testing. Univariate and multivariate analyses assessed potential risk factors for the 3 outcomes of interest. Results were given in adjusted odds ratios (aORs), 95% confidence intervals (CIs), and P values. Results: There was a difference (P = .009) in total morphine equivalent doses used (in 5-milligram oxycodone tablets) between patients who were younger than 65 years of age (median: 83 tablets, interquartile range: 62-140) and those who were older than 65 years of age (median: 65 tablets, interquartile range: 52-90). Unemployment (aOR = 4.68, CI: 1.5-14.2, P = .006) and age less than 65 years (aOR = 4.18, CI: 1.6-11.2, P = .004) were independent risk factors for inadequate pain control 6 weeks postoperatively. Two independent risk factors for needing an opiate prescription refill after discharge were unemployment (aOR = 4.56, CI: 1.5-13.8, P = .007) and preoperative opiate use (aOR = 3.95, CI: 1.4-11.0, P = .009). Conclusion: After TSA, morphine equivalent dose usage is higher for patients younger than 65 years of age, and several risk factors exist for requiring a refill and having inadequate pain control 6 weeks postoperatively. Prospective studies using these data to guide interventions may be beneficial.http://www.sciencedirect.com/science/article/pii/S2666638321001341AgeMorphine equivalent doseOpioidsReverse total shoulder arthroplastyRisk factorsSex |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Kyle J. Kopechek, BS Austin J. Roebke, MD Mathangi Sridharan, BS Richard Samade, MD, PhD Kanu S. Goyal, MD Andrew S. Neviaser, MD Julie Y. Bishop, MD Gregory L. Cvetanovich, MD |
spellingShingle |
Kyle J. Kopechek, BS Austin J. Roebke, MD Mathangi Sridharan, BS Richard Samade, MD, PhD Kanu S. Goyal, MD Andrew S. Neviaser, MD Julie Y. Bishop, MD Gregory L. Cvetanovich, MD The effect of patient factors on opioid use after anatomic and reverse shoulder arthroplasty JSES International Age Morphine equivalent dose Opioids Reverse total shoulder arthroplasty Risk factors Sex |
author_facet |
Kyle J. Kopechek, BS Austin J. Roebke, MD Mathangi Sridharan, BS Richard Samade, MD, PhD Kanu S. Goyal, MD Andrew S. Neviaser, MD Julie Y. Bishop, MD Gregory L. Cvetanovich, MD |
author_sort |
Kyle J. Kopechek, BS |
title |
The effect of patient factors on opioid use after anatomic and reverse shoulder arthroplasty |
title_short |
The effect of patient factors on opioid use after anatomic and reverse shoulder arthroplasty |
title_full |
The effect of patient factors on opioid use after anatomic and reverse shoulder arthroplasty |
title_fullStr |
The effect of patient factors on opioid use after anatomic and reverse shoulder arthroplasty |
title_full_unstemmed |
The effect of patient factors on opioid use after anatomic and reverse shoulder arthroplasty |
title_sort |
effect of patient factors on opioid use after anatomic and reverse shoulder arthroplasty |
publisher |
Elsevier |
series |
JSES International |
issn |
2666-6383 |
publishDate |
2021-09-01 |
description |
Background: Prolonged opioid use can lead to suboptimal outcomes after total shoulder arthroplasty (TSA), and thus, reduced consumption is desirable. Our primary aims were to determine if differences in total morphine equivalent doses existed owing to (1) age less than or greater than 65 years, (2) sex, and (3) TSA type – reverse or anatomic total shoulder arthroplasty. We also characterized potential risk factors for (1) visiting another provider for pain, (2) pain control 6 weeks postoperatively, and (3) needing an opioid refill. Methods: A retrospective cohort study of 100 patients who underwent TSA (reverse total shoulder arthroplasty N1 = 50; anatomic total shoulder arthroplasty N2 = 50) between 1 July 2018 and 31 December 2018 was performed. Demographics, perioperative treatments, and postoperative opioid prescriptions were recorded. Primary hypotheses were evaluated with Wilcoxon-Mann-Whitney testing. Univariate and multivariate analyses assessed potential risk factors for the 3 outcomes of interest. Results were given in adjusted odds ratios (aORs), 95% confidence intervals (CIs), and P values. Results: There was a difference (P = .009) in total morphine equivalent doses used (in 5-milligram oxycodone tablets) between patients who were younger than 65 years of age (median: 83 tablets, interquartile range: 62-140) and those who were older than 65 years of age (median: 65 tablets, interquartile range: 52-90). Unemployment (aOR = 4.68, CI: 1.5-14.2, P = .006) and age less than 65 years (aOR = 4.18, CI: 1.6-11.2, P = .004) were independent risk factors for inadequate pain control 6 weeks postoperatively. Two independent risk factors for needing an opiate prescription refill after discharge were unemployment (aOR = 4.56, CI: 1.5-13.8, P = .007) and preoperative opiate use (aOR = 3.95, CI: 1.4-11.0, P = .009). Conclusion: After TSA, morphine equivalent dose usage is higher for patients younger than 65 years of age, and several risk factors exist for requiring a refill and having inadequate pain control 6 weeks postoperatively. Prospective studies using these data to guide interventions may be beneficial. |
topic |
Age Morphine equivalent dose Opioids Reverse total shoulder arthroplasty Risk factors Sex |
url |
http://www.sciencedirect.com/science/article/pii/S2666638321001341 |
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