Diagnosis can predict opioid usage and dependence in reverse shoulder arthroplasty

摘要

Introduction Reverse shoulder arthroplasty (RSA) has seen exponential growth over the past 2 decades. In addition, the recent focus on opioid usage and dependence has led to an increased understanding of the risk factors that lead to dependence. The purpose of this study was to examine associations between diagnosis and opioid consumption and dependence in RSA. Methods A retrospective review was performed of 441 patients who had undergone a primary RSA from 2012 to 2016. Demographics were collected and patients were categorized based on top 4 diagnoses: glenohumeral osteoarthritis (n = 129), irreparable rotator cuff tear (n = 85), rotator cuff arthropathy (RCA) (n = 184), and proximal humerus fracture (n = 69). Opioid consumption within 90 days surrounding surgery was recorded from Prescription Drug Monitoring Programs. Logistic regression was performed. Results Baseline characteristics for sex ( P ?= .0001), ethnicity ( P ?= .04), age ( P ?= .01), and preoperative opioid use ( P ?= .029) were significantly different. Patients with osteoarthritis had the lowest preoperative total morphine equivalents (TMEs) at 22.82 compared with fractures (53.36, P ?= .02) and RCA (46.54, P ?= .02). There was no significant difference in preoperative opioid dependence based on diagnosis ( P ?= .16); however, postoperatively, the RCA group had the highest dependence at 40.3% ( P ?= .03). In addition, there were no significant differences postoperatively in TMEs prescribed ( P ?= .197). The preoperatively dependent patients were 8 times more likely to remain dependent regardless of diagnosis. Conclusion Patients with fractures consume the highest amounts of opioids surrounding surgery. Surgeons should tailor their preoperative education and pain management protocols accordingly based on diagnoses for RSA. In addition, increased awareness and protocols need to be implemented for preoperative opioid-dependent patients regardless of diagnosis.