Fort Michael W, Leinweber Kathleen A, Werth Paul M, Lin Timothy J, Bell John-Erik, Austin Daniel C
Department of Orthopaedic Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
OrthoVirginia Inc., Richmond, VA, USA.
JSES Int. 2024 Sep 10;9(2):517-523. doi: 10.1016/j.jseint.2024.08.200. eCollection 2025 Mar.
Orthopedic surgery has been highlighted as a contributor to the opioid epidemic. There is a paucity of literature focused specifically on opioid prescribing trends following shoulder surgery. Our aims were to describe national and regional trends in opioid prescribing following total shoulder arthroplasty, proximal humerus fracture fixation, and rotator cuff repair (RCR), and to correlate opioid prescribing trends after shoulder surgery with regional heroin use and new opioid misuse diagnoses.
This is a retrospective study of 218,577 patients from a commercial insurance dataset who had undergone orthopedic shoulder procedures from 2014 to 2020. Opioid prescription data within 90-day postoperative were converted to morphine milligram equivalents (MMEs). Multivariate modelling was used to evaluate independent associations between MME's prescribed and subsequent new postoperative diagnosis of opioid dependence. Additionally, longitudinal mixed effects modeling was employed to understand aggregated prescriber habits by state over time and the subsequent effects on estimates of state heroin use and drug overdose deaths.
From 2014 to 2020, the mean number of MMEs prescribed nationally decreased by over 50% for total shoulder arthroplasty, proximal humerus fracture fixation, and RCR. Over the study period, most states demonstrated an overall downtrend of 90-day opioid prescribing for these procedures. Individuals with a new opioid misuse diagnosis following shoulder surgery were found to be younger (standardized mean difference [SMD] = 0.27, < .001), have increased comorbidities (SMD = 0.38, < .001), and increased MME's prescribed (SMD = 0.94, < .001). Increased comorbidity score (odds ratio [OR] = 3.28, < .001) and increased 90-day MME's prescribed (OR = 1.05, < .001) were all found to increase the OR of a postoperative opioid misuse diagnosis in patient's undergoing shoulder surgery, while increased age (OR = 0.97, < .001) and patient's undergoing RCR (OR = 0.79, = .001) were found to have a decreased OR of developing a new opioid misuse diagnosis. The predictors of regional heroin use included the within-state 90-day MMEs prescribed ( = .002). The predictors of drug overdose death included year ( < .001), but did not include type of surgery or 90-day MMEs.
Orthopedic surgeons successfully reduced the number of opioids prescribed nationally after shoulder surgeries by over 50% during our study period with similar trends seen at the state level. Our data indicate a relationship between increased opioid prescribing after shoulder surgery and heroin use. This study highlights that while progress has been made, there is evidence that opioid prescribing following shoulder surgery is associated with the more widespread opioid epidemic, and that more research is needed to further lower postoperative opioid misuse in the future.
骨科手术被认为是导致阿片类药物泛滥的一个因素。专门关注肩部手术后阿片类药物处方趋势的文献较少。我们的目的是描述全肩关节置换术、肱骨近端骨折固定术和肩袖修复术（RCR）后阿片类药物处方的全国和地区趋势，并将肩部手术后的阿片类药物处方趋势与地区海洛因使用情况及新的阿片类药物滥用诊断相关联。
这是一项对218577例来自商业保险数据集的患者进行的回顾性研究，这些患者在2014年至2020年间接受了骨科肩部手术。术后90天内的阿片类药物处方数据被转换为吗啡毫克当量（MMEs）。采用多变量建模来评估所开具的MMEs与随后新的术后阿片类药物依赖诊断之间的独立关联。此外，采用纵向混合效应建模来了解各州随时间推移的总体处方习惯以及对各州海洛因使用估计和药物过量死亡的后续影响。
从2014年到2020年，全肩关节置换术、肱骨近端骨折固定术和RCR的全国MMEs平均处方数量减少了50%以上。在研究期间，大多数州这些手术的90天阿片类药物处方总体呈下降趋势。肩部手术后有新的阿片类药物滥用诊断的个体更年轻（标准化平均差[SMD]=0.27，P<0.001），合并症更多（SMD=0.38，P<0.001），且开具的MMEs更多（SMD=0.94，P<0.001）。合并症评分增加（比值比[OR]=3.28，P<0.001）和90天开具的MMEs增加（OR=1.05，P<0.001）均被发现会增加接受肩部手术患者术后阿片类药物滥用诊断的OR值，而年龄增加（OR=0.97，P<0.001）和接受RCR手术的患者（OR=0.79，P=0.
