Female Sex, Fibromyalgia Diagnosis, Obesity, Tobacco Use, Preoperative Opioid Use, and Postoperative Recurrent Instability Are Risk Factors for Return to the Emergency Department 1 Year After Arthroscopic Shoulder Stabilization

Abstract

Purpose

To identify risk factors for return to the emergency department (ED) 1 year after arthroscopic shoulder stabilization and to evaluate secondary outcomes related to postoperative opioid use and recurrent shoulder instability.

Methods

We retrospectively identified patients aged 18 to 30 years old undergoing first-time arthroscopic shoulder stabilization (Current Procedural Terminology code 29806). The PearlDiver database was queried for patients between 2017 and 2019 with minimum of 3 months preoperatively to 24 months postoperative assessment, to analyze returns to the emergency department (ED), 1-year postsurgery opioid use, and recurrent instability.

Results

Among 12,223 patients, 2,643 (21.6%) patients had at least 1 ED visit within 1-year postoperation. Factors significantly associated (P < .01) included sex (odds ratio [OR] 0.65), obesity (OR 1.71), tobacco use (OR 3.57), perioperative interscalene nerve block (OR 1.23), and recurrent instability (OR 1.49). When the analysis was carried out in the 642 (5.3%) patients with 3 or more postoperative ED visits, significant predictors (P < .01) were female sex (OR 0.49), fibromyalgia (OR 1.42), obesity (OR 1.96), tobacco use (OR 4.25), preoperative opioid use (OR 1.53), nerve block (OR, 1.36), and recurrent instability (OR 2.19). At 1 year postoperative, 2,160 (17.7%) patients were still taking opioids, with significant predictors (P < .01) of age (OR 1.02), sex (OR 0.58), fibromyalgia (OR 1.46), obesity (OR 1.24), tobacco use (OR 1.60), and preoperative opioid use (OR, 1.86). Recurrent instability was found in 1,012 (8.3%) patients, and tobacco use (OR, 1.60) and preoperative opioid use (OR, 1.29) were significantly predictive (P < .01).

Conclusions

Factors predictive of return to ED 1 year after arthroscopic shoulder stabilization included female sex, fibromyalgia diagnosis, obesity, tobacco use, preoperative opioid use, and postoperative recurrent instability. Factors predictive of opioid use 1 year postoperatively included female sex, obesity, tobacco use, and recurrent instability but not preoperative opioid use. Factors predictive of recurrent instability included female sex and tobacco use.

Level of Evidence

Level IV, prognostic study.