Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA.
Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA.
J Shoulder Elbow Surg. 2021 May;30(5):1025-1033. doi: 10.1016/j.jse.2020.08.007. Epub 2020 Aug 25.
The incidence of total shoulder arthroplasty (TSA) in increasing. Evidence in primary hip and knee arthroplasty suggest that preoperative opioid use is a risk factor for postoperative complication. This relationship in TSA is unknown. The purpose of this study was to investigate this relationship.
The Truven Marketscan claims database was used to identify patients who underwent primary, unilateral TSA. Preoperative opioid use status was then used to divide patients into cohorts based on the average daily oral morphine equivalents (OMEs) received in the 6-month preoperative period. This included the following cohorts: opioid naïve and <1, 1-5, 5-10, and >10 average daily OMEs. In total, 29,454 patients with 90-day postoperative follow-up were included. Of these, 21,580 patients and 8959 patients had 1- and 3-year follow-up, respectively. Patient information and complication data were collected. Univariate and multivariate logistic regression were then performed to assess the association of preoperative opioid use with postoperative outcomes. A subgroup analysis was performed to examine revision surgery at 1 and 3 years postoperatively.
Forty-four percent of identified patients received preoperative opioids, but the preoperative opioid-naïve patient became more common over the study period. Multivariate analysis demonstrated that patients receiving >10 average daily OMEs (compared with opioid naïve) had higher odds of opioid overdose (odds ratio [OR] 4.17, 95% confidence interval [CI] 1.57-11.08, P = .004), wound complication (OR 2.04, 95% CI 1.44-2.89, P < .001), superficial surgical site infection (OR 2.33, 95% CI 1.63-3.34, P < .001), prosthetic joint infection (OR 3.41, 95% CI 2.50-4.67, P < .001), pneumonia (OR 1.95, 95% CI 1.39-2.75, P < .001), and thromboembolic event (OR 1.42, 95% CI 1.18-1.72, P < .001). The same group had higher health care utilization, including extended length of stay, nonhome discharge, readmission, and emergency department visits (P ≤ .001). Total perioperative adjusted costs were more than $7000 higher in the >10-OME group when compared to preoperative opioid-naïve patients.
Opioid use prior to TSA is common and is associated with increased complications, health care utilization, revision surgery, and costs. This risk is dose dependent, and efforts should be made at cessation prior to surgery.
全肩关节置换术（TSA）的发病率正在上升。髋关节和膝关节初次置换术的证据表明，术前使用阿片类药物是术后并发症的一个危险因素。在 TSA 中，这种关系尚不清楚。本研究的目的是调查这种关系。
使用 Truven Marketscan 索赔数据库确定接受初次、单侧 TSA 的患者。然后根据术前 6 个月内平均每日口服吗啡当量（OME）的使用情况，将患者分为以下队列：阿片类药物未使用和<1、1-5、5-10 和>10 个平均每日 OME。共有 29454 名患者接受了 90 天的术后随访。其中，21580 名患者和 8959 名患者分别有 1 年和 3 年的随访。收集患者信息和并发症数据。然后进行单变量和多变量逻辑回归分析，以评估术前使用阿片类药物与术后结局的关系。进行了亚组分析，以检查术后 1 年和 3 年的翻修手术。
44%的患者在术前使用了阿片类药物，但在研究期间，术前阿片类药物未使用的患者变得更为常见。多变量分析表明，接受>10 个平均每日 OME（与阿片类药物未使用相比）的患者发生阿片类药物过量的可能性更高（比值比[OR] 4.17，95%置信区间[CI] 1.57-11.08，P =.004）、伤口并发症（OR 2.04，95%CI 1.44-2.89，P<.001）、浅表手术部位感染（OR 2.33，95%CI 1.63-3.34，P<.001）、人工关节感染（OR 3.41，95%CI 2.50-4.67，P<.001）、肺炎（OR 1.95，95%CI 1.39-2.75，P<.001）和血栓栓塞事件（OR 1.42，95%CI 1.18-1.72，P<.001）。同一组患者的医疗保健利用率更高，包括延长住院时间、非家庭出院、再入院和急诊就诊（P≤.001）。与术前阿片类药物未使用的患者相比，接受>10 OME 的患者围手术期总调整费用高出 7000 多美元。
术前使用阿片类药物在 TSA 中很常见，并且与并发症增加、医疗保健利用率增加、翻修手术和成本增加有关。这种风险与剂量有关，术前应努力停止使用阿片类药物。
