Predictors and prescribing patterns of opioid medications surrounding reverse shoulder arthroplasty

Vani J Sabesan, Matthew Stankard, Jordan Grauer, Nikolas Echeverry, Kiran Chatha, Vani J Sabesan, Matthew Stankard, Jordan Grauer, Nikolas Echeverry, Kiran Chatha

Abstract

Background: Opioid analgesics play an essential role in postoperative pain management; however, they are also associated with high rates of abuse and decreased patient outcomes. With the declaration of the recent opioid crisis, more scrutiny has been placed on physicians and their prescribing habits, and orthopedic surgeons have been shown to be the third-largest providers of opioids. Many patients undergoing reverse shoulder arthroplasty (RSA) have acute and chronic pain and may be prescribed opioids. The purpose of this study was to understand opioid-prescribing patterns across all specialties for patients undergoing RSA.

Methods: A retrospective review of preoperative and postoperative opioid use in 407 patients who underwent RSA from 2012 to 2015 was performed. Demographic data including age, sex, race, ethnicity, body mass index, American Society of Anesthesiologists class, and smoking status were recorded. Opioid prescriptions within 90 days before and after surgery were collected using state-mandated prescription drug-monitoring databases. Prescriber specialty was recorded, and prescriptions were categorized as follows: orthopedic surgery, primary care or internal medicine, pain management and anesthesia, dentistry, and emergency medicine.

Results: The cohort was composed of 236 women (58.0%) and 171 men (42.0%). The average age was 71 years. Forty-six percent of patients received preoperative prescriptions, of which 24.7% were written by orthopedic surgeons and 60.0% were written by internal medicine specialists. Preoperatively, 20% of patients received >3 prescriptions for opioids, and postoperatively, 36.4% of patients received >3 opioid prescriptions. Fifty-nine percent of all postoperative prescriptions were written by orthopedists, and 35.2% were written by internal medicine specialists.

Conclusion: Not surprisingly, orthopedic surgeons prescribed the majority of postoperative prescriptions. Increased awareness, however, of preoperative prescribing habits by other specialty providers may be needed, with communication of their prescriptions to orthopedists, as preoperative use is the strongest predictor of postoperative dependence on opioids. Physicians should be aware of the number of patients receiving multiple prescriptions and their contribution to dependence with continued refills postoperatively. Therefore, surgeons must be more meticulous in assessing opioid consumption before surgery, as well as which providers are writing prescriptions after surgery, to limit opioid dispensation.

Keywords: Opioids; opioid dependence; opioid prescribing; provider specialty; reverse shoulder arthroplasty.

© 2020 Published by Elsevier Inc. on behalf of American Shoulder and Elbow Surgeons.

Figures

Figure 1
Figure 1
Percentage of patients receiving opioid prescriptions (Rx) surrounding reverse shoulder arthroplasty by physician subspecialty. Preop, preoperative; Postop, postoperative; Ortho, orthopedic surgery; IM, internal medicine; Pain, pain medicine; ER, emergency medicine.
Figure 2
Figure 2
Proportion of preoperative opioid prescriptions by specialty. ER, emergency medicine.
Figure 4
Figure 4
Proportion of postoperative opioid prescriptions by specialty. ER, emergency medicine.
Figure 3
Figure 3
Number of patients filling preoperative opioid prescriptions.
Figure 5
Figure 5
Number of patients filling postoperative opioid prescriptions after reverse shoulder arthroplasty (RSA).

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Source: PubMed

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