Obesity cited among risk factors for patient opioid use prior to shoulder arthroplasty

ByMax R. Wursta

Female sex, younger age, obesity and low socioeconomic status may be risk factors for preoperative opioid use in patients undergoing primary anatomic total shoulder arthroplasty, according to published results.

Perspective from Thomas (Quin) W. Throckmorton, MD, FAAOS

Researchers studied 982 patients in a prospective total shoulder arthroplasty (TSA) registry who underwent primary anatomic TSA for treatment of primary glenohumeral OA. Investigators assessed patient demographics and clinical characteristics including age, sex, BMI, socioeconomic status (SES), smoking status, history of chronic back pain, depression, diabetes mellitus and cardiovascular disease, according to the study.

Preoperative opioid use was determined by asking the patient: “Do you take narcotic pain medication (codeine or stronger) for your shoulder—yes or no?” SES was determined using the area disability index. Other clinical outcomes included the Constant score, American Shoulder and Elbow Surgeons score, single assessment numeric evaluation (SANE) and range of motion. Researchers separated patients into either a preoperative opioid use group or a non-opioid group.

According to the study, 254 patients (25.9%) were taking preoperative opioids for shoulder pain. After performing multivariate logistic regression, researchers found an association between female sex, younger age, BMI of greater than 30 kg/m², chronic back pain and lower SES with increased preoperative opioid use. The preoperative opioid use group also reported worse ASES and Constant scores.

“The authors are not aware of a specific physiological explanation for poorer outcomes in patients with preoperative opioid use; however, there appears to be a clear association with worse outcomes in patients with preoperative opioid use,” they wrote. “Education directed to primary care and referring providers may also be warranted to discuss the detrimental effect of opioids on TSA outcomes, along with strategies to treat symptoms of severe shoulder pain and OA in patients who initially prefer not to be referred for surgery,” they added.

Perspective

Thomas (Quin) W. Throckmorton, MD, FAAOS

In this study, Morris and colleagues have nicely added to our understanding of preoperative opioid use in shoulder arthroplasty. Their previous work, and that of others, has clearly shown that opioid use is associated with inferior outcomes following shoulder replacement. However, we did not understand the factors that contributed to patients using these medications before surgery. These results indicate a number of variables may predict preoperative opioid use, including sex, age, obesity and lower socioeconomic status (SES). Unfortunately, other than obesity, these factors are not realistically modifiable so attempts to address or mitigate them before surgery are not possible. As such, these variables are best served as data points for surgeons to consider and discuss with patients prior to shoulder replacement to better inform them of their expected outcomes Finally, this study highlights the value and need for predictive modeling programs that surgeons can use to accurately predict patient outcomes following shoulder arthroplasty.

Thomas (Quin) W. Throckmorton, MD, FAAOS

Professor, shoulder and elbow surgery

Department of orthopedic surgery

University of Tennessee-Campbell Clinic

Memphis, Tennessee

Disclosures: Throckmorton reports he is a paid consultant for Osteocentrics, Responsive Arthroscopy and Zimmer Biomet; and receives royalties from Exactech, Responsive Arthroscopy and Zimmer Biomet.

Published by:

Sources/Disclosures

Collapse

Source:

Morris BJ, et al. Orthopedics. 2020;doi:10.3928/01477447-20200721-12.

Disclosures: Morris reports he is a paid consultant for Tornier Inc. (Wright Medical Group NV) and receives an honorarium from DJ Orthopaedics. Please see the study for all other authors’ relevant financial disclosures.

Opioid Resource Center

Read more

Obesity cited among risk factors for patient opioid use prior to shoulder arthroplasty

Perspective

Related Content