Effect of opioid dependence or abuse on opioid utilization after shoulder arthroplasty

Abstract

Aim: To examine whether opioid dependence or abuse has an effect on opioid utilization after anatomic or reverse total shoulder arthroplasty (TSA).

Methods: All anatomic TSA (ICD-9 81.80) and reverse shoulder arthroplasty (RSA) (ICD-9 81.88) procedures from 2007 to 2015 were queried from within the Humana claims database utilizing the PearlDiver supercomputer (Colorado Springs, CO). Study groups were formed based on the presence or absence of a previous history of opioid dependence (ICD-9 304.00 and 304.03) or abuse (ICD-9 305.50 and 305.53). Opioid utilization among the groups was tracked monthly up to 1 year post-operatively utilizing National Drug Codes. A secondary analysis was performed to determine risk factors for pre-operative opioid dependence or abuse.

Results: Two percent of TSA (157 out of 7838) and 3% of RSA (206 out of 6920) patients had a history of opioid dependence or abuse. For both TSA and RSA, opioid utilization was significantly higher in opioid dependent patients at all post-operative intervals (P < 0.01) although the incidence of opioid use among groups was similar within the first post-operative month. After TSA, opioid dependent patients were over twice as likely to fill opioid prescriptions during the post-operative months 1-12. Following RSA, opioid dependent patients were over 3 times as likely to utilize opioids from months 3-12. Age less than 65 years, history of mood disorder, and history of chronic pain were significant risk factors for pre-operative opioid dependence/abuse in patients who underwent TSA or RSA.

Conclusion: Following shoulder arthroplasty, opioid use between opioid-dependent and non-dependent patients is similar within the first post-operative month but is greater among opioid-dependent patients from months 2-12.

Keywords: Abuse; Anatomic total shoulder arthroplasty; Chronic pain; Dependence; Mood disorder; Narcotic; Opioid; Reverse shoulder arthroplasty.

Figure 1

Percent of patients filling at least one opioid prescription within each post-operative interval following reverse shoulder arthroplasty. Within the first post-operative month, patients with a history of opioid dependence/abuse were slightly more likely to fill opioid prescriptions (RR = 1.36, 95%CI: 1.27-1.45, P < 0.001). However, they were over 3 times as likely to use opioids during post-operative months 3-12 (RR ranged 3.09-3.50, 95%CI: 2.67-4.10, P < 0.001).

Figure 2

Percent of patients filling at least one opioid prescription within each post-operative interval following reverse shoulder arthroplasty. Within the first post-operative month, patients with a history of opioid dependence/abuse were slightly more likely to fill opioid prescriptions (RR = 1.36, 95%CI: 1.27-1.45, P < 0.001). However, they were over 3 times as likely to use opioids during post-operative months 3-12 (RR ranged 3.09-3.50, 95%CI: 2.67-4.10, P < 0.001).