The relationship between preoperative opioid use and adverse events following total shoulder arthroplasty.

Introduction: Few studies have analyzed the effect of preoperative opioid use on postoperative outcomes after total shoulder arthroplasty (TSA).

Methods: Patients undergoing TSA were identified in the Pearldiver Humana Claims Dataset and stratified by level of preoperative opioid use. Primary outcomes were 90-day complications, readmissions, and revision surgery. Chi-square test and ANOVA were used to evaluate categorical and continuous variables respectively. A multivariable logistic regression analysis and a sub analysis excluding fracture as a primary diagnosis were completed.

Results: 18,791 patients underwent aTSA and rTSA including 9933 opioid naïve patients, 3016 sporadic opioid users and 5842 persistent opioid users. Significant differences were found in complications (6.0% vs 6.1% vs 9.1%, p < .001), readmission (7.6% vs 8.2% vs 12.6%, p < .001), and revision procedures (1.1% vs 1.1% vs 2.3%, p < .001) which remained significant after excluding fractures. After adjusting for comorbidity burden, persistent opioid use was associated with increased likelihood of complications (OR 1.4, 1.2-1.6), readmission (OR 1.6, 1.5-1.8) and revision procedures (OR 1.9, 1.5-2.4). This association remained after excluding fractures.

Conclusion: Persistent preoperative opioid use is associated with increased risk of early postoperative complications, readmission, and revision surgery for patients undergoing shoulder arthroplasty.