The perioperative effects of chronic preoperative opioid use on shoulder arthroplasty outcomes
Chronic opioid therapy is an increasingly used modality for the treatment of osteoarthritis-associated pain. We hypothesized that chronic opioid use would be associated with adverse outcomes in shoulder arthroplasty. A retrospective analysis of patients undergoing elective anatomic total shoulder ar...
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| Veröffentlicht in: | Journal of shoulder and elbow surgery 2017-11, Vol.26 (11), p.1908-1914 |
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| container_title | Journal of shoulder and elbow surgery |
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| creator | Cheah, Jonathan W. Sing, David C. McLaughlin, Dell Feeley, Brian T. Ma, C. Benjamin Zhang, Alan L. |
| description | Chronic opioid therapy is an increasingly used modality for the treatment of osteoarthritis-associated pain. We hypothesized that chronic opioid use would be associated with adverse outcomes in shoulder arthroplasty.
A retrospective analysis of patients undergoing elective anatomic total shoulder arthroplasty (TSA) and reverse total shoulder arthroplasty (rTSA) at a single institution from 2012-2015 was performed. Patients were stratified by preoperative opioid use (nonusers, short-acting opioid users, and long-acting opioid users), and their postoperative clinical outcomes were assessed.
We identified 262 patients (170 rTSA and 92 anatomic TSA), of whom 138 were using opioids preoperatively (82% short acting and 18% long acting). When non-opioid users, short-acting opioid users, and long-acting opioid users were compared, mean total milligrams of morphine equivalents administered during postoperative hospitalization was significantly higher for those with preoperative opioid use (66.9 mg, 111.4 mg, and 208.3 mg, respectively; P |
| doi_str_mv | 10.1016/j.jse.2017.05.016 |
| format | Article |
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A retrospective analysis of patients undergoing elective anatomic total shoulder arthroplasty (TSA) and reverse total shoulder arthroplasty (rTSA) at a single institution from 2012-2015 was performed. Patients were stratified by preoperative opioid use (nonusers, short-acting opioid users, and long-acting opioid users), and their postoperative clinical outcomes were assessed.
We identified 262 patients (170 rTSA and 92 anatomic TSA), of whom 138 were using opioids preoperatively (82% short acting and 18% long acting). When non-opioid users, short-acting opioid users, and long-acting opioid users were compared, mean total milligrams of morphine equivalents administered during postoperative hospitalization was significantly higher for those with preoperative opioid use (66.9 mg, 111.4 mg, and 208.3 mg, respectively; P < .001). In addition, postoperative visual analog scale pain scores were higher on postoperative day 0 (2.6, 3.2, and 3.9, respectively; P = .007), day 1 (4.0, 4.9, and 6.0, respectively; P < .001), and day 2 (3.0, 3.9, and 5.1, respectively; P < .001). Opioid use was not associated with a significantly increased hospital length of stay, complications, or readmission rates. For patients who completed 2-year follow-up, both the opioid user and non–opioid user groups demonstrated similarly improved postoperative American Shoulder and Elbow Surgeons shoulder scores.
A preoperative history of opioid use before shoulder arthroplasty was associated with significantly higher perioperative opioid consumption and visual analog scale scores. However, unlike in patients undergoing total knee or hip arthroplasty, preoperative opioid use was not associated with increased hospital length of stay, perioperative complications, or 90-day readmission rates for shoulder arthroplasty.</description><identifier>ISSN: 1058-2746</identifier><identifier>EISSN: 1532-6500</identifier><identifier>DOI: 10.1016/j.jse.2017.05.016</identifier><identifier>PMID: 28735841</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aged ; Analgesics, Opioid - administration & dosage ; Analgesics, Opioid - therapeutic use ; Arthroplasty, Replacement, Shoulder - adverse effects ; Arthroplasty, Replacement, Shoulder - methods ; chronic pain ; complications ; Elective Surgical Procedures - adverse effects ; Female ; Follow-Up Studies ; Humans ; Length of Stay ; Male ; Middle Aged ; opioid dependence ; opioid use ; Osteoarthritis - complications ; Osteoarthritis - surgery ; Pain Measurement ; Pain, Postoperative - drug therapy ; Pain, Postoperative - etiology ; Patient Readmission ; perioperative outcomes ; Preoperative Period ; Retrospective Studies ; reverse total shoulder arthroplasty ; Shoulder Joint - surgery ; Shoulder Pain - drug therapy ; Shoulder Pain - etiology ; Total shoulder arthroplasty</subject><ispartof>Journal of shoulder and elbow surgery, 2017-11, Vol.26 (11), p.1908-1914</ispartof><rights>2017 Journal of Shoulder and Elbow Surgery Board of Trustees</rights><rights>Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c353t-5f98104a65411ef8837725229aee72a7c5ca2cdb6edfb1d80a5cdf6c7b5472223</citedby><cites>FETCH-LOGICAL-c353t-5f98104a65411ef8837725229aee72a7c5ca2cdb6edfb1d80a5cdf6c7b5472223</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jse.2017.05.016$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>315,782,786,3552,27931,27932,46002</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28735841$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Cheah, Jonathan W.</creatorcontrib><creatorcontrib>Sing, David C.</creatorcontrib><creatorcontrib>McLaughlin, Dell</creatorcontrib><creatorcontrib>Feeley, Brian T.</creatorcontrib><creatorcontrib>Ma, C. Benjamin</creatorcontrib><creatorcontrib>Zhang, Alan L.</creatorcontrib><title>The perioperative effects of chronic preoperative opioid use on shoulder arthroplasty outcomes</title><title>Journal of shoulder and elbow surgery</title><addtitle>J Shoulder Elbow Surg</addtitle><description>Chronic opioid therapy is an increasingly used modality for the treatment of osteoarthritis-associated pain. We hypothesized that chronic opioid use would be associated with adverse outcomes in shoulder arthroplasty.
A retrospective analysis of patients undergoing elective anatomic total shoulder arthroplasty (TSA) and reverse total shoulder arthroplasty (rTSA) at a single institution from 2012-2015 was performed. Patients were stratified by preoperative opioid use (nonusers, short-acting opioid users, and long-acting opioid users), and their postoperative clinical outcomes were assessed.
We identified 262 patients (170 rTSA and 92 anatomic TSA), of whom 138 were using opioids preoperatively (82% short acting and 18% long acting). When non-opioid users, short-acting opioid users, and long-acting opioid users were compared, mean total milligrams of morphine equivalents administered during postoperative hospitalization was significantly higher for those with preoperative opioid use (66.9 mg, 111.4 mg, and 208.3 mg, respectively; P < .001). In addition, postoperative visual analog scale pain scores were higher on postoperative day 0 (2.6, 3.2, and 3.9, respectively; P = .007), day 1 (4.0, 4.9, and 6.0, respectively; P < .001), and day 2 (3.0, 3.9, and 5.1, respectively; P < .001). Opioid use was not associated with a significantly increased hospital length of stay, complications, or readmission rates. For patients who completed 2-year follow-up, both the opioid user and non–opioid user groups demonstrated similarly improved postoperative American Shoulder and Elbow Surgeons shoulder scores.
A preoperative history of opioid use before shoulder arthroplasty was associated with significantly higher perioperative opioid consumption and visual analog scale scores. However, unlike in patients undergoing total knee or hip arthroplasty, preoperative opioid use was not associated with increased hospital length of stay, perioperative complications, or 90-day readmission rates for shoulder arthroplasty.</description><subject>Aged</subject><subject>Analgesics, Opioid - administration & dosage</subject><subject>Analgesics, Opioid - therapeutic use</subject><subject>Arthroplasty, Replacement, Shoulder - adverse effects</subject><subject>Arthroplasty, Replacement, Shoulder - methods</subject><subject>chronic pain</subject><subject>complications</subject><subject>Elective Surgical Procedures - adverse effects</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Length of Stay</subject><subject>Male</subject><subject>Middle Aged</subject><subject>opioid dependence</subject><subject>opioid use</subject><subject>Osteoarthritis - complications</subject><subject>Osteoarthritis - surgery</subject><subject>Pain Measurement</subject><subject>Pain, Postoperative - drug therapy</subject><subject>Pain, Postoperative - etiology</subject><subject>Patient Readmission</subject><subject>perioperative outcomes</subject><subject>Preoperative Period</subject><subject>Retrospective Studies</subject><subject>reverse total shoulder arthroplasty</subject><subject>Shoulder Joint - surgery</subject><subject>Shoulder Pain - drug therapy</subject><subject>Shoulder Pain - etiology</subject><subject>Total shoulder arthroplasty</subject><issn>1058-2746</issn><issn>1532-6500</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kD1PwzAQhi0EoqXwA1iQR5YE24njVEyo4kuqxFJWLNc-q66SONhJpf57XJWPjeXudH7ulfwgdE1JTgmt7rb5NkLOCBU54XnanKAp5QXLKk7IaZoJrzMmymqCLmLcEkLmJWHnaMJqUfC6pFP0sdoA7iE4n4oa3A4wWAt6iNhbrDfBd07jPsDfu--ddwaPMY0djhs_NgYCVmFIdN-oOOyxHwftW4iX6MyqJsLVd5-h96fH1eIlW749vy4elpkueDFk3M5rSkpV8ZJSsHVdCME4Y3MFIJgSmmvFtFlXYOyampooro2ttFjzUjDGihm6Peb2wX-OEAfZuqihaVQHfoySzllBSVXQMqH0iOrgYwxgZR9cq8JeUiIPWuVWJq3yoFUSLtMm3dx8x4_rFszvxY_HBNwfAUif3DkIMmoHnQbjQpIpjXf_xH8B55uKDg</recordid><startdate>201711</startdate><enddate>201711</enddate><creator>Cheah, Jonathan W.</creator><creator>Sing, David C.</creator><creator>McLaughlin, Dell</creator><creator>Feeley, Brian T.</creator><creator>Ma, C. Benjamin</creator><creator>Zhang, Alan L.</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201711</creationdate><title>The perioperative effects of chronic preoperative opioid use on shoulder arthroplasty outcomes</title><author>Cheah, Jonathan W. ; Sing, David C. ; McLaughlin, Dell ; Feeley, Brian T. ; Ma, C. Benjamin ; Zhang, Alan L.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c353t-5f98104a65411ef8837725229aee72a7c5ca2cdb6edfb1d80a5cdf6c7b5472223</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Aged</topic><topic>Analgesics, Opioid - administration & dosage</topic><topic>Analgesics, Opioid - therapeutic use</topic><topic>Arthroplasty, Replacement, Shoulder - adverse effects</topic><topic>Arthroplasty, Replacement, Shoulder - methods</topic><topic>chronic pain</topic><topic>complications</topic><topic>Elective Surgical Procedures - adverse effects</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Length of Stay</topic><topic>Male</topic><topic>Middle Aged</topic><topic>opioid dependence</topic><topic>opioid use</topic><topic>Osteoarthritis - complications</topic><topic>Osteoarthritis - surgery</topic><topic>Pain Measurement</topic><topic>Pain, Postoperative - drug therapy</topic><topic>Pain, Postoperative - etiology</topic><topic>Patient Readmission</topic><topic>perioperative outcomes</topic><topic>Preoperative Period</topic><topic>Retrospective Studies</topic><topic>reverse total shoulder arthroplasty</topic><topic>Shoulder Joint - surgery</topic><topic>Shoulder Pain - drug therapy</topic><topic>Shoulder Pain - etiology</topic><topic>Total shoulder arthroplasty</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Cheah, Jonathan W.</creatorcontrib><creatorcontrib>Sing, David C.</creatorcontrib><creatorcontrib>McLaughlin, Dell</creatorcontrib><creatorcontrib>Feeley, Brian T.</creatorcontrib><creatorcontrib>Ma, C. Benjamin</creatorcontrib><creatorcontrib>Zhang, Alan L.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of shoulder and elbow surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Cheah, Jonathan W.</au><au>Sing, David C.</au><au>McLaughlin, Dell</au><au>Feeley, Brian T.</au><au>Ma, C. Benjamin</au><au>Zhang, Alan L.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The perioperative effects of chronic preoperative opioid use on shoulder arthroplasty outcomes</atitle><jtitle>Journal of shoulder and elbow surgery</jtitle><addtitle>J Shoulder Elbow Surg</addtitle><date>2017-11</date><risdate>2017</risdate><volume>26</volume><issue>11</issue><spage>1908</spage><epage>1914</epage><pages>1908-1914</pages><issn>1058-2746</issn><eissn>1532-6500</eissn><abstract>Chronic opioid therapy is an increasingly used modality for the treatment of osteoarthritis-associated pain. We hypothesized that chronic opioid use would be associated with adverse outcomes in shoulder arthroplasty.
A retrospective analysis of patients undergoing elective anatomic total shoulder arthroplasty (TSA) and reverse total shoulder arthroplasty (rTSA) at a single institution from 2012-2015 was performed. Patients were stratified by preoperative opioid use (nonusers, short-acting opioid users, and long-acting opioid users), and their postoperative clinical outcomes were assessed.
We identified 262 patients (170 rTSA and 92 anatomic TSA), of whom 138 were using opioids preoperatively (82% short acting and 18% long acting). When non-opioid users, short-acting opioid users, and long-acting opioid users were compared, mean total milligrams of morphine equivalents administered during postoperative hospitalization was significantly higher for those with preoperative opioid use (66.9 mg, 111.4 mg, and 208.3 mg, respectively; P < .001). In addition, postoperative visual analog scale pain scores were higher on postoperative day 0 (2.6, 3.2, and 3.9, respectively; P = .007), day 1 (4.0, 4.9, and 6.0, respectively; P < .001), and day 2 (3.0, 3.9, and 5.1, respectively; P < .001). Opioid use was not associated with a significantly increased hospital length of stay, complications, or readmission rates. For patients who completed 2-year follow-up, both the opioid user and non–opioid user groups demonstrated similarly improved postoperative American Shoulder and Elbow Surgeons shoulder scores.
A preoperative history of opioid use before shoulder arthroplasty was associated with significantly higher perioperative opioid consumption and visual analog scale scores. However, unlike in patients undergoing total knee or hip arthroplasty, preoperative opioid use was not associated with increased hospital length of stay, perioperative complications, or 90-day readmission rates for shoulder arthroplasty.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>28735841</pmid><doi>10.1016/j.jse.2017.05.016</doi><tpages>7</tpages></addata></record> |
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| ispartof | Journal of shoulder and elbow surgery, 2017-11, Vol.26 (11), p.1908-1914 |
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| subjects | Aged Analgesics, Opioid - administration & dosage Analgesics, Opioid - therapeutic use Arthroplasty, Replacement, Shoulder - adverse effects Arthroplasty, Replacement, Shoulder - methods chronic pain complications Elective Surgical Procedures - adverse effects Female Follow-Up Studies Humans Length of Stay Male Middle Aged opioid dependence opioid use Osteoarthritis - complications Osteoarthritis - surgery Pain Measurement Pain, Postoperative - drug therapy Pain, Postoperative - etiology Patient Readmission perioperative outcomes Preoperative Period Retrospective Studies reverse total shoulder arthroplasty Shoulder Joint - surgery Shoulder Pain - drug therapy Shoulder Pain - etiology Total shoulder arthroplasty |
| title | The perioperative effects of chronic preoperative opioid use on shoulder arthroplasty outcomes |
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