Journal of shoulder and elbow surgery | 2021
Preoperative opioid usage predicts markedly inferior outcomes two years after reverse total shoulder arthroplasty.
Abstract
BACKGROUND\nReverse total shoulder arthroplasty (RTSA) has proven to be a highly effective treatment for rotator cuff deficient conditions and other end-stage shoulder pathologies. With value-based care emerging, identifying predictive factors of outcomes are of great interest. Although preoperative opioid use has been shown to predict inferior outcomes after anatomic total shoulder arthroplasty and rotator cuff repair, there is a paucity of data regarding its effect on outcomes after RTSA. We analyzed a series of RTSAs to determine the influence of preoperative opioid use on clinical and radiographic outcomes at a minimum of 2 years follow-up.\n\n\nMETHODS\nA retrospective review of primary RTSA patient data revealed 264 patients with at least 2 years of clinical and radiographic follow-up. Patients were classified as preoperative opioid users (71 patients) if they had taken narcotic pain medication for a minimum of 3 months prior to surgery or opioid-naive (193 patients) at the time of surgery. Assessments included preoperative and postoperative visual analog pain scores (VAS), American Shoulder and Elbow Surgeons (ASES) scores, strength, range of motion (ROM), complications, and revisions. Radiographs were analyzed for signs of loosening or mechanical failure. Mann-Whitney U and Fisher exact tests were used for comparisons between groups. Statistical significance was set at p < 0.05.\n\n\nRESULTS\nThe mean patient age was 69.9 years, and the mean follow-up time was 2.8 years. Opioid users were significantly younger (66.1 vs. 70.7 years, p < 0.001) at time of surgery and had significantly higher preoperative rates of mood disorders, chronic pain disorders, and disability status (all p < 0.05). Postoperatively, opioid users had inferior VAS (2.59 vs 1.25, p < 0.001), ASES scores (63.2 vs 75.2, p < 0.001), active forward elevation (p < 0.001), and internal and external rotational shoulder strength (all p < 0.05) than opioid-naïve patients. Periprosthetic radiolucency (8.45% vs 2.07%, p = 0.026) and subsequent revision arthroplasty (14.1% vs 4.66%, p = 0.014) occurred more frequently in opioid users than opioid-naïve patients. Both groups improved from baseline preoperatively to most recent follow-up in terms of functional outcomes and pain.\n\n\nCONCLUSION\nPreoperative opioid use portended markedly inferior clinical outcomes in patients undergoing RTSA. Additionally, opioid users had significantly increased rates of periprosthetic radiolucency and revisions. Preoperative opioid use appears to be a significant marker for adverse outcomes after RTSA.