Preoperative Opioid Prescription is an Independent Risk Factor for Complication and Increased Healthcare Utilization Following Total Shoulder Arthroplasty

OrthoMedia ◽  
2021 ◽  
Keyword(s):  
Risk Factor ◽  
Healthcare Utilization ◽  
Shoulder Arthroplasty ◽  
Independent Risk Factor ◽  
Total Shoulder Arthroplasty ◽  
Opioid Prescription

scholarly journals A higher altitude is an independent risk factor for venous thromboembolisms following total shoulder arthroplasty

2018 ◽  
Vol 15 (4) ◽  
pp. 1017-1021 ◽  
Author(s):  
Dhanur Damodar ◽  
Rushabh Vakharia ◽  
Ajit Vakharia ◽  
Jon Sheu ◽  
Chester J. Donnally ◽  
...  
Keyword(s):  
Risk Factor ◽  
Shoulder Arthroplasty ◽  
Independent Risk Factor ◽  
Total Shoulder Arthroplasty

scholarly journals Shoulder Arthroplasty for Posttraumatic Arthritis Is Associated With Increased Transfusions and Longer Operative Times

2019 ◽  
Vol 3 ◽  
pp. 247154921988213
Author(s):  
Tyler A Luthringer ◽  
Benjamin S Kester ◽  
Oluwadamilola Kolade ◽  
Mandeep S Virk ◽  
Michael J Alaia ◽  
...  
Keyword(s):  
Risk Factor ◽  
Shoulder Arthroplasty ◽  
Independent Risk Factor ◽  
Hospital Admissions ◽  
Total Shoulder Arthroplasty ◽  
Posttraumatic Arthritis ◽  
Improvement Program ◽  
Primary Osteoarthritis ◽  
Poor Outcomes ◽  
Reverse Total Shoulder

Introduction: Posttraumatic arthritis (PTA) is a common sequela of proximal humerus fractures that is commonly managed with anatomic or reverse total shoulder arthroplasty (TSA). TSA for PTA is more challenging than that performed for primary osteoarthritis and frequently leads to worse patient outcomes. CPT uniformly classifies all cases of primary TSA, irrespective of procedural complexity and resource utilization. This study analyzes intraoperative differences and 30-day outcomes for anatomic and reverse TSA performed in the posttraumatic shoulder. Methods: Patients undergoing TSA from 2008 to 2015 were selected from the National Surgical Quality Improvement Program database and stratified according to concurrent procedures and administrative codes indicating posttraumatic diagnoses. Perioperative parameters and 30-day complications were recorded; multivariate analyses were performed to determine whether PTA was a risk factor for poor outcomes. Results: A total of 8508 primary and 243 posttraumatic TSAs were identified. Posttraumatic TSA patients were slightly younger ( P = .003), more likely to be female ( P < .001), smokers ( P = .029), and diabetic ( P =  .003). Diagnosis of PTA was an independent risk factor for prolonged operative times ≥160 minutes (≥1 standard deviation above the mean, P =  .003; odds ratio [OR]: 1.718; 95% confidence interval [CI]: 1.204–2.449) and increased bleeding requiring transfusion ( P <  .001; OR: 2.719; 95% CI: 1.607–4.600). Although posttraumatic TSA had a tendency for longer hospital admissions, 30-day readmissions were not significantly different between cohorts. Conclusions: Compared with primary osteoarthritis, a preoperative diagnosis of PTA is an independent risk factor for prolonged operative times and postoperative transfusion in anatomic or reverse TSA patients; such patients may be less than optimal candidates for same-day discharges or outpatient shoulder arthroplasty.

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.

Emergency Department Visits in the Year Prior to Total Shoulder Arthroplasty as a Risk Factor for Postoperative Emergency Department Visits

2021 ◽  
pp. 155633162199577
Author(s):  
Brian C. Werner ◽  
Francis P. Bustos ◽  
Richard P. Gean ◽  
Matthew J. Deasey
Keyword(s):  
Emergency Department ◽  
Risk Factor ◽  
Lower Extremity ◽  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Significant Risk ◽  
Multivariate Logistic Regression Analysis ◽  
Emergency Department Visits ◽  
Ed Visits ◽  
Increasing Risk

Background: Recent research has found a high rate of emergency department (ED) use after lower extremity arthroplasty; one study found a risk factor for ED presentation after lower extremity arthroplasty was presentation to the ED in the year prior to surgery. It is not known whether a similar association exists for total shoulder arthroplasty (TSA). Questions/Purposes: The goal of this study was to investigate the relationship between preoperative ED visits and postoperative ED visits after anatomic TSA. Methods: The 100% Medicare database was queried for patients who underwent anatomic TSA from 2005 to 2014. Emergency department visits within the year prior to the date of TSA were identified. Patients were additionally stratified by the number and timing of preoperative ED visits. The primary outcome measure was one or more postoperative ED visits within 90 days. A multivariate logistic regression analysis was used to control for patient demographics and comorbidities. Results: Of the 144,338 patients identified, 32,948 (22.8%) had an ED visit in the year prior to surgery. Patients with at least 1 ED visit in the year before surgery presented to the ED at a significantly higher rate than patients without preoperative ED visits (16% versus 6%). An ED visit in the year prior to TSA was the most significant risk factor for postoperative ED visits (in the multivariate analysis). The number of preoperative ED visits in the year prior to surgery demonstrated a significant dose-response relationship with increasing risk of postoperative ED visits. Conclusions: Postoperative ED visits occurred in nearly 10% of Medicare patients who underwent TSA in the period studied. More frequent presentation to the ED in the year prior to anatomic TSA was associated with increasing risk of postoperative ED visits. Future studies are needed to investigate the reasons for preoperative ED visits and if any modifiable risk factors are present to improve the ability to risk stratify and optimize patients for elective TSA.

scholarly journals Comparison of 90-Day Perioperative Outcomes in Shoulder Arthroplasty Between the Elderly and Nonelderly Patients

2018 ◽  
Vol 9 ◽  
pp. 215145931880384
Author(s):  
Paul D. Crook ◽  
William C. Foster ◽  
Stephen L. Kates ◽  
Jonathan R. Korpon ◽  
Gustavo A. Ortega ◽  
...  
Keyword(s):  
Risk Factor ◽  
Elderly Patients ◽  
Complication Rate ◽  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Skilled Nursing Facility ◽  
The Elderly ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
Discharge Disposition

Introduction: As life expectancy increases, the incidence of shoulder arthroplasty continues to increase as well. There are few shoulder arthroplasty studies investigating perioperative complication, readmission, and mortality. Furthermore, with bundled payments on the horizon, the cost of shoulder arthroplasty has become a significant issue. Clarifying risk factors for the need for postdischarge acute care will be critical information due to the high cost of such care. The goal of this study was to compare discharge disposition, length of stay (LOS), perioperative complications, readmission, and mortality in elderly and nonelderly cohorts to determine whether age is a risk factor for shoulder arthroplasty. Materials and Methods: We retrospectively compared 89 elderly patients (80 years or older) and 86 nonelderly patients (79 years or younger) who underwent hemiarthroplasty, total shoulder arthroplasty, reverse total shoulder arthroplasty, or revision shoulder arthroplasty from 2007 to 2015. Baseline characteristics were compared between the 2 cohorts. We then compared discharge disposition, LOS, 90-day complication rate, readmission, and mortality between the 2 cohorts. Results: Average length of hospitalization and percentage of patients with greater than 2 days of hospitalization were significantly higher in the elderly cohorts. Forty-four percent of the elderly cohorts were discharged to a skilled nursing facility compared to 6% in the nonelderly cohorts ( P < .0001). There were no significant differences found in 90-day major complication rate, readmission, or mortality. Discussion: Shoulder arthroplasty is a valuable surgery for various indications in the elderly population. However, the likelihood of a patient to need a prolonged hospitalization or skilled nursing facility care after surgery are important questions that need to be answered. Our study shows that age over 80 years is a risk factor for prolonged hospitalization and need for skilled nursing facility care after shoulder arthroplasty. Conclusion: We conclude that elderly patients who undergo shoulder arthroplasty are significantly more likely to have extended hospitalizations and to be discharged to skilled nursing facilities compared to nonelderly patients.

scholarly journals Does Preservation of Coracoacromial Ligament Reduce the Acromial Stress Pathology Following Reverse Total Shoulder Arthroplasty?

2021 ◽  
Vol 5 ◽  
pp. 247154922110221
Author(s):  
Chang Hee Baek, MD ◽  
Jung Gon Kim, MD ◽  
Dong Hyeon Lee, MD ◽  
Gyu Rim Baek
Keyword(s):  
Risk Factor ◽  
Shoulder Arthroplasty ◽  
Total Shoulder Arthroplasty ◽  
Clinical Score ◽  
Reverse Total Shoulder Arthroplasty ◽  
Occult Fracture ◽  
Coracoacromial Ligament ◽  
Group 2 ◽  
Reverse Total Shoulder ◽  
Group 1

Introduction Acromial pathologies (AP), such as acromial stress reaction (ASR), acromial stress occult fracture (ASOF), and acromial stress fracture (ASF), are known as complications that deteriorate the clinical score and patient satisfaction after reverse total shoulder arthroplasty (RSA). Several factors that increase stress on the acromion have been reported as risk factors for AP, but this is also unclear. Thecoracoacromial ligament (CAL) is a structure that distributes the stress loading on such an acromion, although its importance has been mentioned, there is a lack of research. Therefore, we investigated the incidence of AP according to the preservation of the CAL and whether it is a risk factor. Methods The study was retrospectively conducted on patients who underwent RSA from 2016 and 2018. Patients with CAL transection was classified into group 1 and CAL preservation was classified into group 2. ASR and ASOF were identified through symptoms and ultrasound, and ASF identified through simple radiograph or computed tomography. The incidence of AP in each group was checked and compared. Results Of the total of 265 patients. Among 197 cases of group 1, 21 cases of ASR(10.7%), 28 cases of ASOF (14.2%),10 cases of ASF (5.1%), and 59 cases of total AP (29.4%). Among 68 cases in group 2, 2 cases (2.9%) of ASR, 6 cases of ASOF(8.8%), 1 case of ASF (1.5%), and 9 cases of total AP (13.2%). It was confirmed that ASR and ASOP were significantly decreased in the group preserving CAL. (P = .008) Conclusion In the case of preservation of CAL during surgery, it was confirmed that the incidence of ASR, ASOF was reduced. Therefore, preservation of CAL can be regarded as a modifiable risk factor that can reduce the risk of AP by distributing the stress applied to acromion after RSA surgery.

Does Undergoing Outpatient Hand Surgery Lead to Prolonged Opioid Use? A Comparison of Surgical and Nonsurgical Patients

Hand ◽  
2020 ◽  
pp. 155894472096496
Author(s):  
William L. Wang ◽  
Kevin F. Lutsky ◽  
Richard M. McEntee ◽  
Lauren Banner ◽  
Brian M. Katt ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Independent Risk Factor ◽  
Multivariable Analysis ◽  
Monitoring Program ◽  
Hand Surgery ◽  
Surgical Patients ◽  
Control Group ◽  
Opioid Use ◽  
Opioid Prescription

Background: Orthopedic surgical patients in general have been found to be at higher risk for developing opioid dependence in the postoperative period. However, there is conflicting evidence in the literature whether opioid exposure after hand surgery leads to prolonged use. In the absence of a nonoperative control group, it is not clear whether prolonged opioid use in hand surgical patients is related to undergoing a surgical intervention. The purpose of our study to compare opioid prescription fulfillment patterns in surgical and nonoperative patients in a hand surgery practice. Methods: We retrospectively compared 320 patients that underwent elbow, wrist, and hand surgery procedures with 741 nonoperative patients treated by 2 hand surgeons. The Pennsylvania Drug Monitoring Program (PDMP), a mandatory statewide database, was used to evaluate the primary outcomes of filling more than one opioid prescription and filling opioid prescriptions beyond 6 months of the index surgery or clinic visit. Bivariate and multivariable logistic regression analysis was performed using the following variables: surgery, prior benzodiazepine use, and prior opioid use. Results: There was no difference in prior opioid use (15.2% vs 16.9%, P = .51) or prior benzodiazepine (10.4% vs 8.4%, P = .33) use between the nonoperative and operative groups. Patients that underwent surgery had a higher incidence of filling more than one opioid prescription (20.9% vs 8.8%, P < .001). However, continued opioid use was not statistically different between nonoperative and operative patients (2.8% vs 5%, P = .08). Bivariate analysis demonstrated that prior opioids (odds ratio [OR] = 12.94, P < .001) and prior benzodiazepines (OR = 1.95, P < .001) were significant independent risk factors for prolonged opioid use. Multivariable analysis demonstrated prior opioid use to be the only independent risk factor for prolonged opioid use (OR = 12.58, P < .001). Conclusion: Undergoing outpatient hand surgery do not appear to be an independent risk factor for filling opioid prescriptions beyond 6 months. Significant risk factors for prolonged opioid use include prior use of controlled substances, particularly prior opioid use.

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