Trends in analgesic medication claims after primary total shoulder arthroplasty in patients with a mental health diagnosis.

Abstract

Background Opioid overdose has been on the constant rise since the beginning of the opioid epidemic. Orthopedic surgery has the 3rd highest average number of opioid prescriptions per prescriber. Efforts have been made nationally to decrease opioid prescribing and opioid use and abuse. Studies have shown patients with mental health disorders are more likely to be prescribed medications, such as opioids, for chronic pain management. This study aims to investigate the trends in prescription rates of analgesic medications for primary total shoulder arthroplasty (TSA) patients with a history of mental illness, chronic pain, or substance use. Methods A retrospective trends analysis was performed using a national database. Patients who underwent primary TSA were identified using the International Classification of Disease. Patients with diagnoses of mental illness, pain syndromes, and substance use were compared to a control group without diagnoses. Patients with a history of an opioid prescription claim within 6 months before TSA were excluded. Medications prescribed—opioids, gabapentinoids (GBPs), and nonsteroidal anti-inflammatory (NSAIDs)—were identified using Uniform Systems of Classification and codes specific to the database. Annual medication claims rates within 30 days, 90 days, and 1-year after TSA were analyzed with linear regression and compound annual growth. Results A total of 82,692 patients with a history of mental illness, chronic pain, or substance use underwent primary TSA. Among this cohort of patients, opioid prescription claims had significantly increasing trends by 30-days after surgery, however, trends were significantly decreasing by 90-days and 1-year after surgery. Prescription claims for GBPs were significantly increasing by all timepoints after TSA surgery among this cohort. For NSAIDs, prescription claims significantly increased by 30 and 90-days post-surgically while decreasing by the 1-year mark. Conclusion Patients with a diagnostic history of mental health, chronic pain, or substance use have significantly fewer opioid medication prescription claims after total shoulder arthroplasty surgery than patients who do not have those diagnoses. No difference in average prescription claims was observed between groups with GBPs or NSAIDs in the 30-day or 90-day postoperative periods.