Preoperative Opioid Use Is a Risk Factor for Revision Surgery, Complications, and Increased Resource Utilization After Arthroscopic Rotator Cuff Repair

2020 ◽  
Vol 48 (13) ◽  
pp. 3339-3346
Author(s):  
Kevin X. Farley ◽  
Jacob M. Wilson ◽  
Corey C. Spencer ◽  
Spero Karas ◽  
John Xerogeanes ◽  
...  
Keyword(s):  
Risk Factor ◽  
Rotator Cuff ◽  
Revision Surgery ◽  
Rotator Cuff Repair ◽  
Linear Models ◽  
Hospital Admissions ◽  
Oral Morphine ◽  
Opioid Use ◽  
Level Of Evidence ◽  
Cuff Repair

Background: Studies have shown preoperative opioid use to influence outcomes after various surgical procedures. Researchers have not assessed this relationship after rotator cuff repair (RCR). Hypothesis/Purpose: The purpose was to assess the relationship between preoperative opioid use and outcomes after arthroscopic RCR. We hypothesized that patients prescribed higher daily averages of preoperative oral morphine equivalents (OMEs) would show increased rates of 90-day complications and 3-year revision surgery. Study Design: Cohort study; Level of evidence, 3. Methods: The MarketScan claims database was utilized to identify patients who underwent arthroscopic RCR between 2009 and 2018. We used preoperative opioid use status to divide patients into groups based on the average daily OMEs consumed in the 6 months before surgery: opioid-naïve, <1, 1-<5, 5-<10, and ≥10 OMEs per day. We retrieved 90-day complication and 3-year revision surgery rates. Opioid use groups were then compared with binomial logistic regression and generalized linear models. Results: We identified 214,283 patients. Of those patients, 50.7% did not receive any preoperative opioids, while 7.7%, 26.8%, 6.3%, and 8.6% received <1, 1-<5, 5-<10, and ≥10 OMEs per day over a 6-month time period, respectively. Complications increased with increasing preoperative OMEs. Multivariate analysis revealed that any patient using ≥1 OME per day had increased rates of 3-year revision surgery, reoperations, and infections. Specifically, patients averaging ≥10 OMEs per day showed a 103% (odds ratio, 2.03 [95% CI, 1.62-2.54]; P < .001) increase in the odds of revision surgery compared with opioid-naïve patients. Rates of hospital admissions and postoperative emergency department encounters were higher in all opioid use groups. Adjusted differences in 6-month preoperative and 3-month postoperative health care costs were seen in the opioid use groups compared with opioid-naïve patients, ranging from US$1307 to US$5820 ( P < .001). Conclusion: Preoperative opioid use was a risk factor for complications and revision surgery after arthroscopic RCR. We also observed a dose-dependent response between opioid use and postoperative complications.

Minimum 10-Year Outcomes of Primary Arthroscopic Transosseous-Equivalent Double-Row Rotator Cuff Repair

2021 ◽  
pp. 036354652110154
Author(s):  
Adam M. Johannsen ◽  
Justin W. Arner ◽  
Bryant P. Elrick ◽  
Philip-C. Nolte ◽  
Dylan R. Rakowski ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Revision Surgery ◽  
Rotator Cuff Repair ◽  
Patient Reported Outcomes ◽  
Long Term Results ◽  
Double Row ◽  
Kaplan Meier ◽  
Patient Reported ◽  
Cuff Repair

Background: Modern rotator cuff repair techniques demonstrate favorable early and midterm outcomes, but long-term results have yet to be reported. Purpose: To determine 10-year outcomes and survivorship after arthroscopic double-row transosseous-equivalent (TOE) rotator cuff repair. Study Design: Case series; Level of evidence 4. Methods: The primary TOE rotator cuff repair procedure was performed using either a knotted suture bridge or knotless tape bridge technique on a series of patients with 1 to 3 tendon full-thickness rotator cuff tears involving the supraspinatus. Only patients who were 10 years postsurgery were included. Patient-reported outcomes were collected pre- and postoperatively, including American Shoulder and Elbow Surgeons (ASES), 12-Item Short Form Health Survey (SF-12), Single Assessment Numeric Evaluation (SANE), shortened version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH), and satisfaction. Kaplan-Meier survivorship analysis was performed. Failure was defined as progression to revision surgery. Results: A total of 91 shoulders (56 men, 31 women) were included between October 2005 and December 2009. Mean follow-up was 11.5 years (range, 10.0-14.1 years). Of 91 shoulders, 5 (5.5%) failed and required revision surgery. Patient-reported outcomes for patients who survived were known for 80% (69/86). Outcomes scores at final follow-up were as follows: ASES, 93.1 ± 10.8; SANE, 87.5 ± 14.2; QuickDASH, 11.1 ± 13.5; and SF-12 physical component summary (PCS), 49.2 ± 10.1. There were statistically significant declines in ASES, SANE, and SF-12 PCS from the 5-year to 10-year follow-up, but none of these changes met the minimally clinically important difference threshold. Median satisfaction at final follow-up was 10 (range, 3-10). From this cohort, Kaplan-Meier survivorship demonstrated a 94.4% survival rate at a minimum of 10 years. Conclusion: Arthroscopic TOE rotator cuff repair demonstrates high patient satisfaction and low revision rates at a mean follow-up of 11.5 years. This information may be directly utilized in surgical decision making and preoperative patient counseling regarding the longevity of modern double-row rotator cuff repair.

The Incidence of Chronic Opioid Use Following Arthroscopic Rotator Cuff Repair

2019 ◽  
Vol 35 (12) ◽  
pp. e11-e12
Author(s):  
Richard E. Campbell ◽  
Danielle Weekes ◽  
Michael DeFrance ◽  
Jenna Feldman ◽  
Fotios Tjoumakaris ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Arthroscopic Rotator Cuff Repair ◽  
Opioid Use ◽  
Chronic Opioid Use ◽  
Arthroscopic Rotator Cuff ◽  
Cuff Repair

scholarly journals The Incidence of Chronic Opioid Use Following Arthroscopic Rotator Cuff Repair and Patient Opioid Education

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0025
Author(s):  
Danielle G. Weekes ◽  
Jenna A. Feldman ◽  
Richard E. Campbell ◽  
Michael DeFrance ◽  
Fotios P. Tjoumakaris ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Shoulder Function ◽  
Arthroscopic Rotator Cuff Repair ◽  
Prescription Data ◽  
Opioid Use ◽  
Significant Difference ◽  
Chronic Opioid Use ◽  
Arthroscopic Rotator Cuff ◽  
Cuff Repair

Objectives: Opioids are commonly prescribed for pain management following Arthroscopic Rotator Cuff Repair (ARCR). While their efficacy outweighs their risks in the short term, chronic opioid use is associated with significant adverse effects, such as dependence, endocrine imbalance or respiratory depression. The rate of chronic opioid use and dependence following ARCR is unknown. The purpose of this study is to determine the rate of chronic opioid use following ARCR and establish the effect of preoperative opioid education on reducing chronic consumption. A secondary aim is to determine if any correlation exists between chronic opioid use and shoulder functionality. Methods: A prospective, randomized study of 140 patients undergoing ARCR was performed with a minimum follow-up of 24 months. Patients were randomized to receive preoperative opioid education (risks of abuse, dependence, etc.) or no education. State registry database opioid prescription data monitoring software were utilized to search for all opioid prescriptions following ARCR in our patient population and this was compared to our electronic medical database for accuracy/discrepancy. The total number of opioid prescriptions and number of tablets was determined as well as time from surgery to most recent prescription. Patients were contacted to determine a shoulder Single Assessment Numeric Evaluation (SANE) score and Visual Analog Scale (VAS) pain score. Categorical data was analyzed via chi-squared tests as appropriate. Numeric data was analyzed using t-tests as appropriate. Results: Forty-five patients (32%) continued to fill opioid prescriptions chronically following ARCR. Seventeen (38%) of these patents received pre-operative opioid educated, whereas twenty-eight (62%) did not (p=0.05). Sixty percent of patients with a history of pre-operative opioid use continued to take opioids, while 23% of opioid naive patients continued (p< 0.01). There was no significant difference in SANE (p= 0.53) or VAS (p= 0.65) scores between the education and control group. Patients taking opioids prior to surgery had worse SANE scores (71.28) than the non-users (86.28), p< 0.01. Conclusion: Almost a third of patients will chronically use opioids following ARCR, including 23% of opioid naive patients. Preoperative opioid use is strongly associated with chronic opioid utilization, as well as decreased shoulder function 2 years after ARCR. Preoperative opioid education significantly decreased the rate of chronic opioid use; however, there is no effect on long-term shoulder function. [Table: see text]

scholarly journals Augmented latissimus dorsi transfer: initial results in patients with massive irreparable posterosuperior rotator cuff tears

2018 ◽  
Vol 11 (1_suppl) ◽  
pp. 59-67 ◽  
Author(s):  
Claudia C. Sidler-Maier ◽  
Jennifer A. Mutch ◽  
Martin Sidler ◽  
Dimitra Leivadiotou ◽  
Jubin B. Payandeh ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Rotator Cuff Repair ◽  
Latissimus Dorsi ◽  
Negative Impact ◽  
Case Series ◽  
Rotator Cuff Tears ◽  
Subscapularis Tendon ◽  
Level Of Evidence ◽  
Latissimus Dorsi Transfer ◽  
Cuff Repair

Background The surgical treatment of irreparable massive rotator cuff tears is challenging. The purpose of the present study was to report the initial outcomes after a modified latissimus dorsi transfer (LDT) augmented by acellular dermal allograft (ADA). Methods This retrospective study includes 24 patients managed with LDT using ADA augmentation as a bursal-sided onlay between March 2009 and December 2015. Results All patients were men with a mean age of 57 years (range 48 years to 70 years). Seven patients had a previously failed rotator cuff repair and ten patients presented with a deficient subscapularis tendon. At last follow-up (mean 27 months), there was a significant improvement in active forward flexion (mean increase 31°; p = 0.016), and abduction by 25° ( p = 0.059). The acromiohumeral distance remained stable and the failure rate was low (4%). Neither a history of previous rotator cuff surgery, nor the presence of a subscapularis tear had a negative impact on functional outcome. Conclusions In our cohort of patients, LDT augmented with ADA was a reasonable option for patients with previously failed rotator cuff repair, as well as in the subgroup of patients with a deficient subscapularis tendon. Level of evidence Level IV: Therapeutic study (case series)

scholarly journals Complications and Revision Surgery after Suture Anchor Rotator Cuff Repair (SS-51)

2002 ◽  
Vol 18 (5) ◽  
pp. 42
Author(s):  
Anand M. Murthi ◽  
Neil S. Roth ◽  
Greg S. Lervick ◽  
Louis U. Bigliani
Keyword(s):  
Rotator Cuff ◽  
Revision Surgery ◽  
Rotator Cuff Repair ◽  
Suture Anchor ◽  
Cuff Repair
Sign in / Sign up

Export Citation Format

Share Document