Preoperative opioid use and outcomes after reverse shoulder arthroplasty

Morris, Brent J.; Laughlin, Mitzi S.; Elkousy, Hussein; Gartsman, Gary M.; Edwards, T. Bradley

doi:10.1016/j.jse.2014.05.002

Cited by 136 publications

(99 citation statements)

References 27 publications

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“…Although functional outcomes were not assessed in our study, the greater need for posthospitalization care could further be interpreted as a less rapid return of independent functional mobility in this patient population [38,39]. It is possible that lower levels of selfefficacy for managing pain-greater pain catastrophizingand resilience in maintaining function among chronic opioid users contributed to the higher rate of posthospitalization care observed in our study [26,47], and also may partly explain why these patients tend to have worse functional outcomes after orthopaedic procedures [31,32,42,57].…”

Section: Discussionmentioning

confidence: 84%

“…Despite uncertainty regarding the long-term effectiveness of opioids for treating chronic musculoskeletal pain [35,43] and emerging evidence that preoperative opioid use is associated with greater pain, disability, and dissatisfaction after orthopaedic surgery [10,25,31,32,42,53], opioids continue to be prescribed. Although it is well established that high-risk opioid use (abuse or dependence) may result from prolonged opioid exposure during the preoperative period [57], little is known about its prevalence and effect in the perioperative orthopaedic surgery setting.…”

Section: Introductionmentioning

confidence: 99%

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Preoperative Opioid Misuse is Associated With Increased Morbidity and Mortality After Elective Orthopaedic Surgery

Menendez

Ring

Bateman

2015

Clinical Orthopaedics &Amp; Related Research

296

176

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Background Many patients having discretionary orthopaedic surgery take opioids daily, either with a prescription or illicitly, however little is known regarding the prevalence and effect of high-risk opioid use (eg, abuse, dependence) in the perioperative orthopaedic setting. Questions/purposes We sought (1) to determine the prevalence of opioid abuse and dependence in patients undergoing major elective orthopaedic surgery; (2) to characterize the relationship of opioid abuse and dependence with in-hospital postoperative mortality and adverse events, failure to rescue, prolonged length of stay, and nonroutine disposition; and (3) to identify factors associated with high-risk opioid use.

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Section: Discussionmentioning

confidence: 84%

Section: Introductionmentioning

confidence: 99%

Preoperative Opioid Misuse is Associated With Increased Morbidity and Mortality After Elective Orthopaedic Surgery

Menendez

Ring

Bateman

2015

Clinical Orthopaedics &Amp; Related Research

296

176

View full text Add to dashboard Cite

show abstract

“…This is not only of concern because these are patients who will be at high risk of continued nontherapeutic opioid use after injury, but pre-injury opioid use has been associated with poor outcomes across multiple orthopaedic subspecialties. 1,14,15 …”

Section: Discussionmentioning

confidence: 99%

“…On the contrary, opioids are associated with worse clinical outcomes in patients with occupational musculoskeletal disorders and patients undergoing total knee arthroplasty, reverse shoulder arthroplasty, and spine surgery. 1,10,14,15 …”

Section: Introductionmentioning

confidence: 99%

Patterns of Opioid Prescribing for an Orthopaedic Trauma Population

Ruder

Wally

Oliverio³

et al. 2017

Journal of Orthopaedic Trauma

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Objectives To determine opioid prescribing practices to the orthopaedic trauma (OT) population at one level I trauma center. Design A retrospective study of discharge prescriptions for adult OT patients. Prescription details, injury burden, and patient demographics were abstracted for patients from initial injury through 2 month follow up. Setting A busy level I trauma center. Patients/Participants Adult OT patients admitted over a 30-day period (n=110). Intervention All discharge and follow-up opioid prescriptions were recorded. Main Outcome Measurements Morphine milligram equivalents per day, Number of opioid prescriptions, type/dose of medication prescribed Results 135 Discharge prescriptions were written for 110 patients with orthopaedic injuries during the review period (Table 1). All patients received opioids at the time of discharge (Table 2). The MMEs prescribed at the time of discharge was 114 mg (54–300 mg) for a mean of 7.21 days (2–36.7 days). While patients with pre-injury risk factors were prescribed discharge opioids for a similar duration (7.00 days, versus 7.30 days, p=0.81) than those without risk factors, they were prescribed significantly more MMEs than those without (130 versus 108, p<.05), and were more likely to receive ER/LA opioids than those without (42.11% versus 21.98%). Conclusions Pain management after orthopaedic trauma continues to be opioid-centric despite involving a population at risk. Further focus on prescriber and patient education, risk evaluation with mitigation, guideline development, and comprehensive pain management strategies are warranted in the orthopaedic trauma population.

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“…19,20 Not only has the management of postoperative pain been adversely affected by opiate use, but the misuse of opioids has been linked to significant increases in morbidity and mortality after orthopaedic procedures. 22 In other areas of shoulder and elbow surgery, preoperative pain and anticipated postoperative pain were found to be significant predictors of increased postoperative pain in a prospective study. A similar trend towards increased postoperative pain and worse overall outcomes has been found in patients taking opioids prior to reverse total shoulder arthroplasty.…”

Section: Risk Factorsmentioning

confidence: 94%

Pain after rotator cuff repair

Roberson

Throckmorton

2016

Current Orthopaedic Practice

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Rotator cuff repair is known to be a painful procedure and therefore an area of particular focus in the perioperative period. The operating surgeon must be aware of several patient-specific risk factors that augment this response and be prepared to either deal with these preoperatively or augment pain management strategies postoperatively in select groups. Among the highest risk patients are those with mood disorders and those taking narcotic pain medication preoperatively. Additional technical risk factors for increased pain include concomitant procedures performed at the time of rotator cuff repair. Although performing these surgeries arthroscopically may provide early decreased pain and earlier treatment effects, there does not appear to be a long-term difference in terms of pain between arthroscopic and mini-open rotator cuff repair techniques. Anesthesia options exist for the benefit of postoperative pain, and these may be considered in the hands of the experienced and skilled anesthesiologist. Multimodal pain management provides a burgeoning area for continued improvement in conjunction with these other areas.

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Preoperative opioid use and outcomes after reverse shoulder arthroplasty

Cited by 136 publications

References 27 publications

Preoperative Opioid Misuse is Associated With Increased Morbidity and Mortality After Elective Orthopaedic Surgery

Preoperative Opioid Misuse is Associated With Increased Morbidity and Mortality After Elective Orthopaedic Surgery

Patterns of Opioid Prescribing for an Orthopaedic Trauma Population

Pain after rotator cuff repair

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