Effects of opioid-limiting legislation on postoperative opioid use in shoulder arthroplasty in an epidemic epicenter

Raji, Yazdan; Strony, John; Trivedi, Nikunj N.; Kroneberger, Elisabeth; Yu, Jiao; Calcei, Jacob G.; Voos, James E.; Gillespie, Robert J.

doi:10.1016/j.jse.2021.07.001

Journal of Shoulder and Elbow Surgery

2022

DOI: 10.1016/j.jse.2021.07.001

|View full text |Cite

Effects of opioid-limiting legislation on postoperative opioid use in shoulder arthroplasty in an epidemic epicenter

Yazdan Raji

John Strony

Nikunj N. Trivedi

et al.

Help me understand this report

Search citation statements

Order By: Relevance

Paper Sections

Select...

Citation Types

Supporting

Mentioning

Contrasting

Year Published

2022

2024

Publication Types

Select...

Article5

Relationship

Self Cite2

Independent3

Authors

Journals

Cited by 6 publications

(8 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Several studies have identified specific patient demographics and preoperative factors predictive of increased and prolonged use of opioids after an upper extremity surgery. 18 , 32 , 45 , 52 , 61 In the present literature, considerable evidence suggests that preoperative opioid consumption, abuse, or dependence is predictive of increased opioid consumption, prolonged use, and dependence perioperatively and postoperatively ( Table I ). 4 , 13 , 14 , 19 , 39 , 41 , 42 , 43 , 47 , 50 , 52 , 56 , 68 Preoperative opioid use has also been linked to worse clinical outcomes and lower rates of patient satisfaction.…”

mentioning

confidence: 98%

“… 18 , 32 , 45 , 52 , 61 In the present literature, considerable evidence suggests that preoperative opioid consumption, abuse, or dependence is predictive of increased opioid consumption, prolonged use, and dependence perioperatively and postoperatively ( Table I ). 4 , 13 , 14 , 19 , 39 , 41 , 42 , 43 , 47 , 50 , 52 , 56 , 68 Preoperative opioid use has also been linked to worse clinical outcomes and lower rates of patient satisfaction. 12 , 49 , 63 Sabesan et al found that, compared to other pathologies, use of a reverse shoulder arthroplasty after a proximal humerus fracture was associated with an increased postoperative opioid dependence, and Jildeh et al found specific surgical factors including presence of biceps tenodesis and number of concomitant procedures significantly increased postoperative opioid demand.…”

mentioning

confidence: 98%

See 1 more Smart Citation

Application of risk assessment tools to predict opioid usage after shoulder surgery

Khoury¹,

Stephens²,

Brown³

et al. 2022

JSES International

View full text Add to dashboard Cite

mentioning

confidence: 98%

mentioning

confidence: 98%

Application of risk assessment tools to predict opioid usage after shoulder surgery

Khoury¹,

Stephens²,

Brown³

et al. 2022

JSES International

View full text Add to dashboard Cite

mentioning

confidence: 99%

“…Earlier studies from various states have shown that opioid-limiting legislation has been largely successful in reducing the amount of opioids that are prescribed after certain orthopaedic procedures. 4,[14][15][16][17][18] Although opioid-prescribing legislation has been successful in reducing the amount of opioids that are prescribed postoperatively, the effect of such policy on prescription practices and rates of ED utilization, reoperations, and readmissions after hip arthroscopy is currently unknown. It is important to ascertain this effect for numerous reasons.…”

mentioning

confidence: 99%

Effects of Opioid-Limiting Legislation and Increased Provider Awareness on Postoperative Opioid Use and Complications After Hip Arthroscopy

Strony

Raji

Ina

et al. 2023

Orthopaedic Journal of Sports Medicine

Self Cite

View full text Add to dashboard Cite

Background: On August 31, 2017, Ohio passed legislation that regulates how opioids can be prescribed postoperatively. Studies have shown that such legislation is successful in reducing the morphine milligram equivalents (MMEs) prescribed after certain orthopaedic procedures. Purpose: (1) To determine if the opioid prescription–limiting legislation in Ohio reduced the cumulative MMEs prescribed after hip arthroscopy without significantly affecting the rates of emergency department (ED) visits, hospital readmissions, and reoperations within 90 days postoperatively, and (2) to assess risk factors associated with increased postoperative opioid dosing. Study Design: Cohort study; Level of evidence, 3. Methods: This study included patients who underwent primary and revision hip arthroscopy at a single institution over a 4-year period. The prelegislation (PRE) and postlegislation (POST) groups were defined as patients who underwent surgery before August 31, 2017, and on/after this date, respectively. The Ohio Automated Rx Reporting System was queried for controlled-substance prescriptions from 30 days preoperatively to 90 days postoperatively, and patient medical records were reviewed to collect demographic, medical, surgical, and readmission data. Inverse probability weighting–adjusted mean treatment effect regression models were used to measure the difference in mean outcomes between the PRE and POST cohorts. Results: A total of 546 patients (228 PRE, 318 POST) were identified. There was a 25% reduction in the cumulative MMEs prescribed to the POST group as compared with the PRE group during the first 90 days postoperatively (840 vs 1125 MME, respectively; P < .01). The legislation was associated with a significant decrease in the cumulative MMEs prescribed in the first 90 postoperative days (mean treatment effect = –280.6; P < .01), and there were no significant between-group differences in the frequency of ED encounters (8.8% PRE, 11.6% POST; P = .32), hospital readmissions (1.3% PRE, 0.9% POST; P = .70), or reoperations (0.9% PRE, 0.6% POST; P ≥ .99) during this period. Preoperative opioid use was a significant independent risk factor for increased cumulative MMEs in the first 90 days postoperatively (β = 275; P < .01). Conclusion: Opioid prescription–limiting legislation in Ohio was associated with significant reductions in opioid MMEs dosing in the 90-day period following hip arthroscopy. This legislation had no significant effect on ED utilization, hospital readmissions, or reoperations within the same period. Preoperative opioid use was a significant risk factor for increased MME dosing after hip arthroscopy.

show abstract

“…Previous studies from various states have demonstrated that opioid prescription–limiting legislation is associated with significant reductions in the number and cumulative dosage of opioids prescribed after numerous orthopaedic procedures. 3,13-17…”

mentioning

confidence: 99%

Effects of Opioid-Limiting Legislation in the State of Ohio on Opioid Prescriptions After Shoulder Arthroscopy

Strony,

Raji,

Trivedi

et al. 2023

Orthopaedic Journal of Sports Medicine

Self Cite

View full text Add to dashboard Cite

Background: Recent studies have shown that legislation regulating opioid prescriptions in the United States has been successful in reducing the morphine milligram equivalent (MME) prescribed after certain orthopaedic procedures. Purpose: To (1) determine the effect of Ohio’s legislation limiting opioid prescriptions after shoulder arthroscopy and (2) identify risk factors associated with prolonged opioid use and increased postoperative opioid dosing. Study Design: Cohort study; Level of evidence, 3. Methods: We reviewed the data of patients who underwent shoulder arthroscopy between January 1, 2016, and March 31, 2020. Patients were classified according to the date of legislation passage (August 31, 2017) as before legislation (PRE) or on/after legislation (POST). Patients were also classified based on the number of opioid prescriptions filled within 30 days of surgery as opioid-tolerant (at least 1 prescription) or opioid-naïve (zero prescriptions). We recorded patient characteristics, medical comorbidities, and surgical details, as well as the number of opioid prescriptions, MME per prescription from 30 days preoperatively to 90 days postoperatively, and the number of gamma-aminobutyric acid (GABA) analogues and benzodiazepine prescriptions from 30 days preoperatively to the date of surgery. Differences between cohorts were compared with the Fisher exact test and Wilcoxon test. A covariate-adjusted regression analysis was used to evaluate risk factors associated with increased postoperative opioid dosing. Results: Overall, 279 patients (n = 97 PRE; n = 182 POST; n = 42 opioid-tolerant; n = 237 opioid-naïve) were included in the final analysis. There was a significant reduction in the cumulative MME prescribed in the immediate (0-7 days) postoperative period (PRE, 450 MME vs POST, 315 MME), the first 30 postoperative days (PRE, 590 MME vs POST, 375 MME), and the first 90 postoperative days (PRE, 600 MME vs POST, 420 MME) ( P < .001 for all). The opioid-tolerant cohort had higher MME at every time point in the postoperative period ( P < .001). Consumption of preoperative opioid (β = 1682.5; P < .001), benzodiazepine (β = 468.09; P < .001), and GABA analogue (β = 251.37; P = .04) was associated with an increase in the cumulative MME prescribed. Conclusion: Opioid prescription–limiting legislation in Ohio significantly reduced the cumulative MME prescribed in the first 30 days postoperatively for both opioid-naïve and opioid-tolerant patients after shoulder arthroscopy. Consumption of opioids, benzodiazepines, and GABA analogues preoperatively was associated with increased postoperative opioid dosage.

show abstract

scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.

Contact Info

hi@scite.ai

10624 S. Eastern Ave., Ste. A-614

Henderson, NV 89052, USA

Blog Terms and Conditions API Terms Privacy Policy Contact Cookie Preferences Do Not Sell or Share My Personal Information

Made with 💙 for researchers

Part of the Research Solutions Family.

Effects of opioid-limiting legislation on postoperative opioid use in shoulder arthroplasty in an epidemic epicenter

Cited by 6 publications

References 20 publications

Application of risk assessment tools to predict opioid usage after shoulder surgery

Application of risk assessment tools to predict opioid usage after shoulder surgery

Effects of Opioid-Limiting Legislation and Increased Provider Awareness on Postoperative Opioid Use and Complications After Hip Arthroscopy

Effects of Opioid-Limiting Legislation in the State of Ohio on Opioid Prescriptions After Shoulder Arthroscopy

Contact Info

Product

Resources

About