Opioid use following a total shoulder arthroplasty: who requires refills and for how long?
Introduction: Pain control following a total shoulder arthroplasty (TSA) is multifactorial. The current standard of care includes the utilization of a multimodal analgesic approach including breakthrough prescription opioid medication in an effort to provide postoperative analgesia. While this origi...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2021-05-01
|
| Series: | JSES International |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666638321000815 |
| _version_ | 1818729797448105984 |
|---|---|
| author | Corey C. Spencer, BS Jeremiah A. Pflederer, MD Jacob M. Wilson, MD Alexander M. Dawes, BS Michael B. Gottschalk, MD Eric R. Wagner, MD |
| author_facet | Corey C. Spencer, BS Jeremiah A. Pflederer, MD Jacob M. Wilson, MD Alexander M. Dawes, BS Michael B. Gottschalk, MD Eric R. Wagner, MD |
| author_sort | Corey C. Spencer, BS |
| collection | DOAJ |
| description | Introduction: Pain control following a total shoulder arthroplasty (TSA) is multifactorial. The current standard of care includes the utilization of a multimodal analgesic approach including breakthrough prescription opioid medication in an effort to provide postoperative analgesia. While this original opioid prescription is sufficient for the majority of patients, some go on to require prolonged opioid use. Our study investigated patient risk factors associated with opioid refill postsurgery. Methods: The Truven Marketscan® database was queried for all patients who underwent either a primary anatomic TSA or primary reverse TSA from 2010 to 2017. Opioid data were collected using National Drug Codes (NDC) from outpatient pharmacy claims. Only opioid-naïve patients were included. Patients were then grouped into 1 of 3 cohorts based on postoperative opioid use: 1) Patients with no additional refills, 2) patients with a minimum of one additional refill up through 6 months postoperatively, and 3) patients with additional refills and continued opioid use past 6 months. Results: Of the total of 17,706 opioid-naïve patients that underwent a TSA, 10,882 (61.5%) did not have any additional refills, 4473 (25.3%) required an additional prescription within 6 months after surgery, and 2351 (13.3%) had prolonged opioid use beyond 6 months postoperatively. A dose-dependent relationship was identified between initial opioid prescription quantity and risk for refill and prolonged use. The prolonged use group was prescribed an equivalent of 20.0 more 5 mg oxycodone pills than the no refill group and 12.7 more than the refill group (P < .001). On multivariate analysis, younger age, female gender, and tobacco use, along with the comorbidities of coronary artery disease, clinical depression, diabetes, and rheumatic disease were all found to be predictive factors of prolonged opioid use. Discussion: The dose-dependent relationship observed between original opioid prescription data and number of additional refills needed, suggests that initially overprescribing opioids may lead to prolonged dependency. This study also identified several independent risk factors for prolonged opioid use, including younger age, depression, and tobacco use. This study will hopefully help recognize high-risk patient populations and serve as the foundation for future studies into opioid prescription standardization and preoperative opioid education. |
| first_indexed | 2024-12-17T22:51:36Z |
| format | Article |
| id | doaj.art-6f73569543f24f628fcd157d15177c4e |
| institution | Directory Open Access Journal |
| issn | 2666-6383 |
| language | English |
| last_indexed | 2024-12-17T22:51:36Z |
| publishDate | 2021-05-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JSES International |
| spelling | doaj.art-6f73569543f24f628fcd157d15177c4e2022-12-21T21:29:40ZengElsevierJSES International2666-63832021-05-0153346352Opioid use following a total shoulder arthroplasty: who requires refills and for how long?Corey C. Spencer, BS0Jeremiah A. Pflederer, MD1Jacob M. Wilson, MD2Alexander M. Dawes, BS3Michael B. Gottschalk, MD4Eric R. Wagner, MD5Emory University School of Medicine, Department of Orthopaedics, Atlanta, GA, USAEmory University School of Medicine, Department of Orthopaedics, Atlanta, GA, USAEmory University School of Medicine, Department of Orthopaedics, Atlanta, GA, USAEmory University School of Medicine, Department of Orthopaedics, Atlanta, GA, USAEmory University School of Medicine, Department of Orthopaedics, Atlanta, GA, USACorresponding author and requests for reprints author: Eric Wagner, MD, Emory University School of Medicine, Department of Orthopaedics, 59 S Executive Park NW, Atlanta, GA 30329, USA.; Emory University School of Medicine, Department of Orthopaedics, Atlanta, GA, USAIntroduction: Pain control following a total shoulder arthroplasty (TSA) is multifactorial. The current standard of care includes the utilization of a multimodal analgesic approach including breakthrough prescription opioid medication in an effort to provide postoperative analgesia. While this original opioid prescription is sufficient for the majority of patients, some go on to require prolonged opioid use. Our study investigated patient risk factors associated with opioid refill postsurgery. Methods: The Truven Marketscan® database was queried for all patients who underwent either a primary anatomic TSA or primary reverse TSA from 2010 to 2017. Opioid data were collected using National Drug Codes (NDC) from outpatient pharmacy claims. Only opioid-naïve patients were included. Patients were then grouped into 1 of 3 cohorts based on postoperative opioid use: 1) Patients with no additional refills, 2) patients with a minimum of one additional refill up through 6 months postoperatively, and 3) patients with additional refills and continued opioid use past 6 months. Results: Of the total of 17,706 opioid-naïve patients that underwent a TSA, 10,882 (61.5%) did not have any additional refills, 4473 (25.3%) required an additional prescription within 6 months after surgery, and 2351 (13.3%) had prolonged opioid use beyond 6 months postoperatively. A dose-dependent relationship was identified between initial opioid prescription quantity and risk for refill and prolonged use. The prolonged use group was prescribed an equivalent of 20.0 more 5 mg oxycodone pills than the no refill group and 12.7 more than the refill group (P < .001). On multivariate analysis, younger age, female gender, and tobacco use, along with the comorbidities of coronary artery disease, clinical depression, diabetes, and rheumatic disease were all found to be predictive factors of prolonged opioid use. Discussion: The dose-dependent relationship observed between original opioid prescription data and number of additional refills needed, suggests that initially overprescribing opioids may lead to prolonged dependency. This study also identified several independent risk factors for prolonged opioid use, including younger age, depression, and tobacco use. This study will hopefully help recognize high-risk patient populations and serve as the foundation for future studies into opioid prescription standardization and preoperative opioid education.http://www.sciencedirect.com/science/article/pii/S2666638321000815Shoulder arthroplastyOpioidsPostoperative careOpioid educationOsteoarthritisUpper extremtiy |
| spellingShingle | Corey C. Spencer, BS Jeremiah A. Pflederer, MD Jacob M. Wilson, MD Alexander M. Dawes, BS Michael B. Gottschalk, MD Eric R. Wagner, MD Opioid use following a total shoulder arthroplasty: who requires refills and for how long? JSES International Shoulder arthroplasty Opioids Postoperative care Opioid education Osteoarthritis Upper extremtiy |
| title | Opioid use following a total shoulder arthroplasty: who requires refills and for how long? |
| title_full | Opioid use following a total shoulder arthroplasty: who requires refills and for how long? |
| title_fullStr | Opioid use following a total shoulder arthroplasty: who requires refills and for how long? |
| title_full_unstemmed | Opioid use following a total shoulder arthroplasty: who requires refills and for how long? |
| title_short | Opioid use following a total shoulder arthroplasty: who requires refills and for how long? |
| title_sort | opioid use following a total shoulder arthroplasty who requires refills and for how long |
| topic | Shoulder arthroplasty Opioids Postoperative care Opioid education Osteoarthritis Upper extremtiy |
| url | http://www.sciencedirect.com/science/article/pii/S2666638321000815 |
| work_keys_str_mv | AT coreycspencerbs opioidusefollowingatotalshoulderarthroplastywhorequiresrefillsandforhowlong AT jeremiahapflederermd opioidusefollowingatotalshoulderarthroplastywhorequiresrefillsandforhowlong AT jacobmwilsonmd opioidusefollowingatotalshoulderarthroplastywhorequiresrefillsandforhowlong AT alexandermdawesbs opioidusefollowingatotalshoulderarthroplastywhorequiresrefillsandforhowlong AT michaelbgottschalkmd opioidusefollowingatotalshoulderarthroplastywhorequiresrefillsandforhowlong AT ericrwagnermd opioidusefollowingatotalshoulderarthroplastywhorequiresrefillsandforhowlong |