Preoperative tramadol linked with decreased risk profile after TSA compared with opioids
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Key takeaways:
- Tramadol prior to TSA was associated with a decreased risk profile compared with patients who received preoperative opioids.
- The tramadol cohort had an increased risk profile compared with opioid-naïve patients.
Results showed patients who received tramadol prior to total shoulder arthroplasty had decreased risk for complications, resource utilization, infection and revision compared with patients who received traditional preoperative opioids.
John M. Kopriva, MD, and colleagues used the IBM Watson Health Marketscan databases to perform a retrospective cohort study of data from 29,454 patients who underwent primary TSA from 2009 to 2018. Researchers categorized patients into four groups: opioid naïve (50.8%, n = 14,953), tramadol (7.5%, n = 2,214), traditional opioids (35.5%, n = 10,462) and combination of opioids and tramadol (6.2%, n = 1,825). Outcomes included prescribed narcotics, complications, resource utilization, prosthetic joint infection and revision surgery.
Researchers found the proportion of patients prescribed traditional preoperative opioids decreased significantly during the study period, while the proportion of patients who were opioid naïve or received preoperative tramadol increased.
Compared with the opioid-naïve cohort, patients in the traditional opioid cohort had increased odds of overall complications, revision at 1 year and 3 years and resource utilization, while patients in the tramadol cohort had no increased risk profile. Rates of prosthetic joint infection were 0.62% in the opioid-naïve cohort, 0.32% in the tramadol cohort, 1.22% in the traditional opioid cohort and 1.21% in the combination cohort.
However, researchers noted the tramadol cohort had an increased risk for negative postoperative outcomes compared with the opioid-naïve cohort.
“As the health care system and orthopedic surgeons focus on limiting narcotic use, tramadol may offer an alternative to traditional opioids for temporizing analgesia as patients are optimized and indicated for TSA,” the researchers wrote in the study.
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