Preoperative opioid use is associated with increased readmission, revision surgery and cost after total shoulder arthroplasty

Abstract

BackgroundPreoperative opioid use has been associated with higher pain scores and lower functional outcomes after total shoulder arthroplasty (TSA), but the association between preoperative opioid use and readmission, revision surgery and cost following TSA is less well-known. The purpose of this study is to determine the association between preoperative opioid use and readmission, revision surgery and cost after total shoulder arthroplasty. MethodsUsing the Marketscan© administrative claims database, we identified patients from 2010–2015 who underwent primary TSA using Current Procedural Terminology codes. 5,621 patients aged 18–64 were identified who had 6-months of continuous coverage preoperatively and one year of continuous coverage postoperatively. Patients who were using opioids up until the 30-day period prior to surgery were classified as preoperative opioid users. Our primary outcomes were rates of 90-day all-cause hospital readmission, 1-year rates of revision surgery, and 1-year healthcare payments. Logistic regression and a generalized linear model were used to analyze binomial and payment data, respectively. All models were controlled for age, gender and Charlson comorbidity index. ResultsMean age of patients was 57 ± 5.6 years, 42% were females. Average length of stay was 1.7 ± 1.2 days. 28% of patients were using opioids preoperatively. Preoperative opioid use was associated with significantly increased odds of 90-day readmission (OR 2.6, p<0.001), having a revision TSA within 1-year (OR 2.35, p<0.001), and higher total postoperative 1-year healthcare payments (+$10,034, p<0.001). Preoperative opioid use was also associated with a small, but significant increased length of stay (+0.13 days, p = 0.001). ConclusionsPreoperative opioid use is associated with increased rates of readmission and revision surgery following TSA. Patients undergoing TSA have significantly higher total healthcare costs and a modest increase in length of hospital stay. Level of evidenceLevel II