Preoperative opioid use is associated with a more painful postoperative course after reverse total shoulder arthroplasty

Abstract

BackgroundStudies investigating preoperative use of opioid medication and early postoperative outcomes are lacking in reverse total shoulder arthroplasty (RTSA), findings that would be relevant in the setting of bundled payment plans. This study compared patients with chronic preoperative opioid use with patients who were opioid naïve in regard to pain, opioid use, length of hospital stay, and complications after RTSA. MethodsPatients using opioids chronically (>3 months) preoperatively and those not using opioid medications before RTSA were identified through an institutional database. Visual analog scale (VAS) pain scores were recorded at the preoperative visit and 12 weeks after surgery. Oral morphine equivalents (OME) were recorded from in-hospital use, discharge, and subsequent opioid prescriptions, and a search of a statewide controlled substances monitoring database was performed during the 3-month postoperative period. The hospital length of stay and complications also were recorded. Statistical analyses for preoperative and postoperative measurements were performed using Mann-Whitney testing. Differences with P < .05 were considered statistically significant. ResultsThere were 55 patients with chronic preoperative opioid use and 134 nonusers included in the study. Preoperative VAS scores (6.7 vs. 5.6; P = .01) were found to be higher for the opioid group. At 3 months postoperatively, VAS (3.5 vs. 1.9; P = .04) was again found to be higher for the opioid group. However, the degree of improvement in VAS (4.1 vs. 3.6; P = .65) was similar between groups. The amount of inpatient OME (66.6 vs. 55; P = .76) and postdischarge OME (606 vs. 559; P = .76) consumed were similar between groups. The cumulative 3-month postoperative OME use (1457 vs. 569; P = .07) was higher in the opioid group and trended toward statistical significance. No differences were noted in the length of stay between the 2 groups, with each averaging 2.3 days. Complication rates were similar between the 2 groups in the 90-day episode of care (9.1% vs. 10.4%). ConclusionThese results indicate that chronic preoperative opioid use is associated with increased postoperative pain after RTSA, although VAS improvement was similar to narcotic-naïve patients. Furthermore, cumulative OME usage only trended toward statistical significance but, nevertheless, reflected an over 2.5-fold increased requirement in the group of patients using opioids preoperatively. Although opioid users did not require substantially more perioperative resources, these data can be used to further counsel patients regarding opioid use, manage postoperative expectations, and aid in risk stratification during the evolution of bundled payments and the transition to value-based care. Level of EvidenceLevel III; Retrospective Case-Control Treatment Study