Opioid Use Following Total Shoulder Arthroplasty: Who Requires Refills and for How Long?

Abstract Introduction Pain control following a total shoulder arthroplasty (TSA) is multifactorial. The current standard of care includes the utilization of a multimodal analgesic approach including breakthrough prescription opioid medication in an effort to provide postoperative analgesia. While this original opioid prescription is sufficient for the majority of patients, some go on to require prolonged opioid use. Our study investigated patient risk factors associated with opioid refill post-surgery. Methods The Truven Marketscan® database was queried for all patients who underwent either a primary anatomic TSA or primary reverse TSA from 2010 to 2017. Opioid data was collected using National Drug Codes (NDC) from outpatient pharmacy claims. Only opioid naive patients were included. Patients were then grouped into one of three cohorts based on postoperative opioid use: 1) Patients with no additional refills, 2) Patients with a minimum of one additional refill up through 6 months postoperatively, and 3) Patients with additional refills and continued opioid use past 6 months. Results Of the total of 17,706 opioid naive patients that underwent a TSA, 10,882 (61.5%) did not have any additional refills, 4,473 (25.3%) required an additional prescription within 6 months after surgery, and 2,351 (13.3%) had prolonged opioid use beyond 6 months postoperatively. A dose dependent relationship was identified between initial opioid prescription quantity and risk for refill and prolonged use. The prolonged use group were prescribed an equivalent of 20.0 more 5mg oxycodone pills than the no refill group and 12.7 more than the refill group (p Discussion The dose-dependent relationship observed between original opioid prescription data and number of additional refills needed, suggests that initially overprescribing opioids may lead to prolonged dependency. This study also identified several independent risk factors for prolonged opioid use, including younger age, depression, and tobacco use. This study will hopefully help recognize high-risk patient populations and serve as the foundation for future studies into opioid prescription standardization and preoperative opioid education. Level of Evidence Level III; Retrospective Case-Control Design using Large Database; Prognosis Study