No significant difference in risk of prolonged opioid use following outpatient versus inpatient total shoulder arthroplasty: A propensity matched analysis

2021 ◽  
pp. 175857322110607
Author(s):  
Michelle Xiao ◽  
Daniel M Curtis ◽  
Emilie V Cheung ◽  
Michael T Freehill ◽  
Geoffrey D Abrams
Keyword(s):  
Shoulder Arthroplasty ◽  
Nearest Neighbor ◽  
Total Shoulder Arthroplasty ◽  
Opioid Use ◽  
Therapeutic Level ◽  
Level Of Evidence ◽  
Opioid Prescription ◽  
Significant Difference ◽  
Outpatient Settings ◽  
Baseline Demographic

Background The purpose of this investigation was to compare rates of filled opioid prescriptions and prolonged opioid use in opioid naïve patients undergoing total shoulder arthroplasty (TSA) in inpatient versus outpatient settings. Methods A retrospective cohort study was conducted using a national insurance claims database. Inpatient and outpatient cohorts were created by identifying continuously enrolled, opioid naïve TSA patients. A greedy nearest-neighbor algorithm was used to match baseline demographic characteristics between cohorts with a 1:1 inpatient to outpatient ratio to compare the primary outcomes of filled opioid prescriptions and prolonged opioid use following surgery between cohorts. Results A total of 11,703 opioid naïve patients (mean age 72.5 ± 8.5 years, 54.5% female, 87.6% inpatient) were included for analysis. After propensity score matching (n = 1447 inpatients; n = 1447 outpatients), outpatient TSA patients were significantly more likely to fill an opioid prescription in the perioperative window compared to inpatients (82.9% versus 71.5%, p < 0.001). No significant differences in prolonged opioid use were detected (5.74% inpatient versus 6.77% outpatient; p = 0.25). Conclusions Outpatient TSA patients were more likely to fill opioid prescriptions compared to inpatient TSA patients. The quantity of opioids prescribed and rates of prolonged opioid use were similar between the cohorts. Level of evidence Therapeutic Level III.

scholarly journals Does Having a Rotator Cuff Repair Before Total Shoulder Arthroplasty Influence Outcomes?

2020 ◽  
Vol 8 (8) ◽  
pp. 232596712094277
Author(s):  
Brandon J. Erickson ◽  
Daphne Ling ◽  
Alexandra Wong ◽  
Joshua S. Dines ◽  
David M. Dines ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Clinical Outcomes ◽  
Shoulder Arthroplasty ◽  
Matched Control ◽  
Total Shoulder Arthroplasty ◽  
Control Group ◽  
Level Of Evidence ◽  
Significant Difference ◽  
History Of ◽  
Glenohumeral Osteoarthritis

Background: The number of rotator cuff repairs (RCRs) is increasing each year. Total shoulder arthroplasty (TSA) is a successful treatment option for patients with glenohumeral osteoarthritis with a functioning rotator cuff. Purpose/Hypothesis: The purposes of this study were to report the outcomes of TSA in patients with ipsilateral RCR and determine whether patients with a history of ipsilateral RCR who subsequently underwent TSA had differences in outcomes compared with matched controls who underwent TSA with no history of RCR. We hypothesized that patients with prior RCR will have significant improvements in clinical outcome scores, with no difference in outcomes after TSA compared with those with no prior RCR. Study Design: Cohort study; Level of evidence, 3. Methods: Patients eligible for inclusion were those with a history of prior RCR who underwent TSA at a single institution with a minimum 2-year follow-up between 2000 and 2015. Outcomes for this group, including American Shoulder and Elbow Surgeons (ASES) scores, were reported and then compared with a matched control group of patients who underwent TSA with no history of prior RCR. Controls were matched based on age, sex, and preoperative ASES score. Results: Overall, 14 patients (64% males; mean ± SD age, 65.1 ± 11.1 years) underwent prior ipsilateral RCR before TSA. ASES scores significantly improved from 42.9 to 78.5 at 2 years and to 86.6 at 5 years. When compared with 42 matched control patients (matched 1:3) who underwent TSA with no history of RCR, there was no significant difference in ASES scores at 2 years (78.5 vs 85.3; P = .19) and 5 years (86.6 vs 90.9; P = .72) between the prior RCR and no RCR groups. Conclusion: TSA in patients with a history of prior ipsilateral RCR led to significant improvements in clinical outcomes. No difference in clinical outcomes at 2 or 5 years after TSA was found between patients with and without a history of prior ipsilateral RCR.

scholarly journals Stress shielding following stemless anatomic total shoulder arthroplasty

2021 ◽  
pp. 175857322110588
Author(s):  
William R Aibinder ◽  
Fares Uddin ◽  
Ryan T Bicknell ◽  
Ryan Krupp ◽  
Markus Scheibel ◽  
...  
Keyword(s):  
Shoulder Arthroplasty ◽  
Functional Outcomes ◽  
Total Shoulder Arthroplasty ◽  
Case Series ◽  
Stress Shielding ◽  
Implant Design ◽  
Level Of Evidence ◽  
Lesser Tuberosity ◽  
Significant Difference

Background Finite element analysis has suggested that stemless implants may theoretically decrease stress shielding. The purpose of this study was to assess the radiographic proximal humeral bone adaptations seen following stemless anatomic total shoulder arthroplasty. Methods A retrospective review of 152 prospectively followed stemless total shoulder arthroplasty utilizing a single implant design was performed. Anteroposterior and lateral radiographs were reviewed at standard time points. Stress shielding was graded as mild, moderate, and severe. The effect of stress shielding on clinical and functional outcomes was assessed. Also, the influence of subscapularis management on the occurrence of stress shielding was determined. Results At 2 years postoperatively, stress shielding was noted in 61 (41%) shoulders. A total of 11 (7%) shoulders demonstrated severe stress shielding with 6 occurring along the medial calcar. There was one instance of greater tuberosity resorption. At the final follow-up, no humeral implants were radiographically loose or migrated. There was no statistically significant difference in clinical and functional outcomes between shoulders with and without stress shielding. Patients undergoing a lesser tuberosity osteotomy had lower rates of stress shielding, which was statistically significant ( p = 0.021) Discussion Stress shielding does occur at higher rates than anticipated following stemless total shoulder arthroplasty, but was not associated with implant migration or failure at 2 years follow-up. Level of evidence IV, Case series.

Single Chest Drain Practice Reduces Discharge Opioid Prescriptions in Thoracic Surgery

2021 ◽  
Author(s):  
Andres Zorrilla-Vaca ◽  
Hope Feldman ◽  
Maria Antonoff ◽  
Boris Sepesi ◽  
Wayne Hofstetter ◽  
...  
Keyword(s):  
Nearest Neighbor ◽  
Length Of Hospital Stay ◽  
Mixed Effects ◽  
Pulmonary Complications ◽  
Chest Drain ◽  
Readmission Rates ◽  
Opioid Prescription ◽  
Significant Difference ◽  
Daily Dose ◽  
Morphine Equivalent

Abstract Introduction Chest drains are placed following pulmonary resection to promote lung re-expansion. The superiority of two chest drains at preventing postoperative complications has not been established, and practice remains largely dictated by surgeon preference. We sought to compare patient outcomes based on number of chest drains used. Methods This is a retrospective analysis including patients undergoing lobectomies and segmentectomies between March 2016 and April 2020. Patients were categorized based on number of chest drains placed and were matched 1:1 using the nearest neighbor (greedy) technique. Our primary outcome was opioid prescriptions at discharge (in morphine equivalent daily dose [MEDD]). Associations were tested using multilevel mixed-effects regression to account for variability between surgeons. Results A total of 1,094 patients met inclusion criteria. Single chest drain was used in 922 patients, whereas 172 had two chest tubes. After matching, there were 111 patients in each group. In multilevel mixed-effects logistic regression, patients treated with a single chest drain received fewer opioid prescriptions (β: −194 MEDD, 95% confidence interval [CI]: −302 to −86 MEDD, p < 0.01), were more likely to be opioid-free at hospital discharge (odds ratio [OR] = 2.11, 95% CI: 1.08–4.12, p = 0.03), and had lower readmission rates within 30 days (OR = 0.33, 95% CI: 0.13–0.84, p = 0.02). Single chest drain practice did not affect the risk of pulmonary complications and there was no statistically significant difference in length of hospital stay (3 days [interquartile range: 2–5] vs. 4 days [3–6], p = 0.08). Conclusion Single chest drain practice in lobectomies and segmentectomies was associated with less opioid prescription requirement without any increase in complications.

Predictors of Long-term Opioid Use After Elective Primary Total Shoulder Arthroplasty

Orthopedics ◽  
2020 ◽  
Author(s):  
Matthew J. Best ◽  
Andrew B. Harris ◽  
Ankit Bansal ◽  
Eric Huish ◽  
Uma Srikumaran
Keyword(s):  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Opioid Use

Glenoid bone grafting in primary anatomic total shoulder arthroplasty: a systematic review

2020 ◽  
pp. 175857322091765
Author(s):  
Betty Zhang ◽  
Gavinn Niroopan ◽  
Chetan Gohal ◽  
Bashar Alolabi ◽  
Timothy Leroux ◽  
...  
Keyword(s):  
Bone Loss ◽  
Shoulder Arthroplasty ◽  
Bone Grafting ◽  
Reverse Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Level Of Evidence ◽  
Total Shoulder Arthroplasties ◽  
Component Loosening ◽  
Shoulder Arthroplasties

Background Primary anatomic total shoulder arthroplasty can be challenging in patients with complex glenoid wear patterns and bone loss. Severe retroversion (>15°) or significant bone loss may require bone grafting. This review summarizes the rate of revision and long-term outcomes of anatomic total shoulder arthroplasty with bone graft. Methods A systematic search of MEDLINE, Embase, PubMed, and CENTRAL databases was conducted from the date of inception to 23 October 2018. Two reviewers independently screened articles for eligibility and extracted data for analysis. The primary outcome was rate of revision. The secondary outcomes were rate of component loosening, functional outcome, and range of motion. Results Of the 1056 articles identified in the search, 26 underwent full-text screening and 7 articles were included in the analysis. All procedures were one-stage anatomic total shoulder arthroplasties. The rate of revision was 5.4% with component loosening and infection listed as indications over a weighted mean follow-up period of 6.3 years. Complications occurred in 12.6% of patients. Conclusion Glenoid bone grafting in anatomic total shoulder arthroplasty results in comparable revision rates and improvement in pain compared to augmented glenoid components and reverse shoulder arthroplasty. Due to the low quality of evidence, further prospective studies should be conducted. Level of evidence IV

A population-based comparison of joint survival of hemiarthroplasty versus total shoulder arthroplasty in osteoarthritis and rheumatoid arthritis

2019 ◽  
Vol 101-B (4) ◽  
pp. 454-460 ◽  
Author(s):  
P. L. C. Lapner ◽  
M. D. Rollins ◽  
C. Netting ◽  
M. Tuna ◽  
A. Bader Eddeen ◽  
...  
Keyword(s):  
Shoulder Arthroplasty ◽  
Statistical Significance ◽  
Total Shoulder Arthroplasty ◽  
Population Based ◽  
Competing Risk ◽  
Income Quintile ◽  
Significant Difference ◽  
Comorbidity Index ◽  
Health Ratio ◽  
Adjusted Association

Aims Few studies have compared survivorship of total shoulder arthroplasty (TSA) with hemiarthroplasty (HA). This observational study compared survivorship of TSA with HA while controlling for important covariables and accounting for death as a competing risk. Patients and Methods All patients who underwent shoulder arthroplasty in Ontario, Canada between April 2002 and March 2012 were identified using population-based health administrative data. We used the Fine–Gray sub-distribution hazard model to measure the association of arthroplasty type with time to revision surgery (accounting for death as a competing risk) controlling for age, gender, Charlson Comorbidity Index, income quintile, diagnosis, and surgeon factors. Results During the study period, 5777 patients underwent shoulder arthroplasty (4079 TSA, 70.6%; 1698 HA, 29.4%), 321 (5.6%) underwent revision, and 1090 (18.9%) died. TSA patients were older (TSA mean age 68.4 years (sd 10.2) vs HA mean age 66.5 years (sd 12.7); p = 0.001). The proportion of female patients was slightly lower in the TSA group (58.0% vs 58.4%). The adjusted association between surgery type and time to shoulder revision interacted significantly with patient age. Compared with TSA patients, revision was more common in the HA group (adjusted-health ratio (HR) 1.214, 95% confidence interval (CI) 0.96 to 1.53) but this did not reach statistical significance. Conclusion Although there was a trend towards higher revision risk in patients undergoing HA, we found no statistically significant difference in survivorship between patients undergoing TSA or HA. Cite this article: Bone Joint J 2019;101-B:454–460.

scholarly journals Surgical treatments of patients with periprosthetic humeral fracture and comorbidities

2021 ◽  
Vol 13 (1) ◽  
pp. 1-4
Author(s):  
Jiayong Liu ◽  
Logan J Roebke ◽  
Josh W Vander Maten ◽  
Meaghan Tranovich ◽  
Nabil A Ebraheim
Keyword(s):  
Shoulder Arthroplasty ◽  
Locking Plate ◽  
Rare Complication ◽  
Case Series ◽  
Humeral Fracture ◽  
Humeral Fractures ◽  
Outcome Analysis ◽  
Level Of Evidence ◽  
Significant Difference ◽  
Cerclage Wiring

Background: Periprosthetic humeral fractures represent a complex and rare complication. Currently, there is no standardized procedure for management or classification of these fractures. Questions/purposes: This unique case series purpose was to look at surgical outcomes and comorbidity profiles of 10 PHF patients. Subsequent analysis looked at whether these outcomes could add to the discussion of a proposed standard of care in a patient cohort with significant comorbidities. Patients and methods: All patients with humeral fractures from 2008-2019 were analyzed for inclusion. A total of ten patients met the inclusion criteria; humeral fracture concurrent with a shoulder arthroplasty. Each patient was managed surgically using a locking plate with or without cerclage wiring. Outcome analysis was then performed for each patient. Humoral fractures managed conservatively were removed from the dataset along with periprosthetic fractures around an elbow arthroplasty, IM nail, or supracondylar fracture after shoulder arthroplasty. Results: The average union time in all patients was 13.27±2.90 (9.86-17.29) weeks. There was no significant difference between patients treated with cerclage wiring or without. All patients had successful union except for a patient with Osteogenesis Imperfecta. There were two radial nerve palsies. The average Deyo-Charlson score and BMI was 7.1±.84 (4-13) and 29.89 respectively. Conclusion: The treatment of PHFs using the technique of ORIF with locking plate with or without cerclage wiring provides satisfactory outcomes in a patient population that usually includes significant comorbidities. Level of evidence: Therapeutic Study Level IV Retrospective Review.

Bilateral total shoulder arthroplasty: A systematic review of clinical outcomes

2020 ◽  
pp. 175857322091682
Author(s):  
John-Rudolph H Smith ◽  
Darby A Houck ◽  
Jessica A Hart ◽  
Jonathan T Bravman ◽  
Rachel M Frank ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Clinical Outcomes ◽  
Shoulder Arthroplasty ◽  
English Language ◽  
External Rotation ◽  
Total Shoulder Arthroplasty ◽  
Cochrane Library ◽  
Level Of Evidence ◽  
Patient Reported

Background The purpose of this study was to describe the clinical outcomes following bilateral total shoulder arthroplasty (TSA). Methods A systematic search of the PubMed, Embase, and Cochrane Library databases following PRISMA guidelines was performed. English-language literature published from 2010 to 2018 analyzing bilateral TSA (anatomic and/or reverse) with a minimum one-year follow-up was reviewed by two independent reviewers. Study quality was evaluated with the Modified Coleman Methodology Score and the methodological index for non-randomized studies score. Results Eleven studies (1 Level II, 3 Level III, 7 Level IV) with 292 patients were included. Two studies reported on bilateral anatomic TSA ( n = 54), six reported on bilateral reverse TSA (RTSA; n = 168), two reported on anatomic TSA with contralateral RTSA (TSA/RTSA; n = 31), and one compared bilateral anatomic TSA ( n = 26) and bilateral RTSA ( n = 13). Among studies, mean revision rate ranged from 0% to 10.53% and mean complication rate ranged from 4.9% to 31.3%. At final follow-up, patients experienced significant overall improvements in range of motion and patient-reported outcome score measurements. However, bilateral anatomic TSA resulted in greater improvements in external rotation compared to bilateral RTSA. Overall patient satisfaction was 91.0%. Conclusion The available data indicate that bilateral TSA allows for functional and pain improvements and result in high patient satisfaction. Level of evidence IV.

Mid-term results of Eclipse total shoulder arthroplasty

2022 ◽  
Vol 104-B (1) ◽  
pp. 83-90
Author(s):  
Timothy J. Batten ◽  
Sian Gallacher ◽  
Jonathan P. Evans ◽  
Richard J. Harding ◽  
Jeffrey Kitson ◽  
...  
Keyword(s):  
At Risk ◽  
Rotator Cuff ◽  
Shoulder Arthroplasty ◽  
Radiolucent Line ◽  
Total Shoulder Arthroplasty ◽  
Independent Study ◽  
Consecutive Series ◽  
Significant Difference ◽  
Mid Term Results

Aims The use and variety of stemless humeral components in anatomical total shoulder arthroplasty (TSA) have proliferated since their advent in 2004. Early outcomes are reassuring but independent mid-term results are scarce. This independent study reports a consecutive series of 143 Eclipse stemless shoulder prostheses with a minimum five-year (5 to 10) follow-up. Methods Outcomes of 143 procedures undertaken for all indications in 131 patients were reviewed, with subset analysis of those for osteoarthritis (OA) (n = 99). The primary outcome was the Oxford Shoulder Score (OSS) at a minimum of five years. Secondary outcomes were ranges of motion and radiological analysis of humeral radiolucency, rotator cuff failure, and glenoid loosening. Results Mean OSS at mean follow-up of 6.67 years (5.0 to 10.74) was 40.12 (9 to 48), with no statistically significant difference between those implanted for a non-OA indication and those for OA (p = 0.056) or time-dependent deterioration between two years and five years (p = 0.206). Ranges of motion significantly improved compared with preoperative findings and were maintained between two and five years with a mean external rotation of 38° (SD 18.1, 0 to 100) and forward elevation of 152° (SD 29.9, 90 to 180). Of those components with radiographs suitable for analysis (n = 83), 23 (28%) were found to have a least one humeral radiolucent line, which were predominantly incomplete, less than 2 mm, and in a single anatomical zone. No humeral components were loose. A radiolucent line was present around 22 (15%) of glenoid components, and 15 (10%) of components had failed. Rotator cuff failure was found in 21 (15%) components. The mean time to either glenoid or rotator cuff failure was greater than three years following implantation. Survivorship was 96.4% (95% CI 91.6 to 98.5, number at risk 128) at five years, and 94.3% (95% CI 88.2 to 97.3, number at risk 76) at seven years, both of which compare favourably with best results taken from available registries. Conclusion Functional and radiological outcomes of the Eclipse stemless TSA are excellent, with no loose humeral components at minimum five-year follow-up. The presence of radiolucent lines is of interest and requires long-term observation but does not impact on the clinical results. Of the eight revisions required, this was predominantly for glenoid and rotator cuff failure. Cite this article: Bone Joint J 2022;104-B(1):83–90.

Can the implementation of the Opioid Start Talking form impact the amount of opioid use in patients after ankle fracture repair?

2021 ◽  
Vol 17 (5) ◽  
pp. 397-404
Author(s):  
Benjamin Best, DO ◽  
Alan Afsari, MD ◽  
Rajan Sharma, DO ◽  
James T. Layson, DO ◽  
Marek Denisiuk, DO
Keyword(s):  
Ankle Fracture ◽  
Final Analysis ◽  
Fracture Repair ◽  
Ankle Fractures ◽  
P Value ◽  
Prescription Database ◽  
Opioid Epidemic ◽  
Opioid Use ◽  
Opioid Prescription ◽  
Significant Difference

Objective: As part of 2018 legislation aimed at fighting the opioid epidemic, the Michigan Department of Health and Human Services (MDHHS) published the “Opioid Start Talking” (OST) Form on June 1, 2018. We examined if the implementation of the OST form led to an identifiable decrease in patient opioid use. Specifically, we examined the opioid prescription quantities in patients who sustained ankle fractures that required open reduction internal fixation (ORIF).Design: Retrospective. Hospital medical records and Michigan Automated Prescription Database (MAPS) were analyzed for similar ankle fracture patients operated on by two surgeons prior to and after the initiation of the OST form. Records allowed us to track opioid filling through MAPS for 120 days after surgery in two groups: preimplementation (PRE) and post-implementation (POST) OST groups. The gathered data were analyzed by the investigators along with a staff statistician.Setting: Single-institution orthopedic practice.Patients, participants: Seventy eight patientsMain outcome measure: Average morphine milligram equivalent (MME) per patient encounter.Results: Seventy eight patients were included in the final analysis after applying the exclusion criteria. There were 38 patients in the pre-OST form period and 40 in the post-OST form period groups. The pre-OST and post-OST groups were well matched between the two surgeons. There was no evidence of a statistically significant difference found in the median MME between patients from the pre-period group to the post-period group (median 59 vs 50, P = 0.61). In regard to the injury pattern, the bimalleolar MME median was 50 (38 = 25th percentile, 67 = 75th percentile; min-max 0-175) and the trimalleolar median MME was 63 (39 =25% percentile, 81 = 75th percentile; min-max 0-249) with a P value of 0.20.Conclusions: Overall, the administration of the OST form to patients with ankle fractures did not result in a decrease in MMEs prescribed within 120 days of surgery. Although it is a start in the battle against the opioid epidemic, further evaluation of the effectiveness of the OST form is necessary.

Sign in / Sign up

Export Citation Format

Share Document