2025 ISAKOS Biennial Congress ePoster
Opioid Prescriptions Following Total Shoulder Arthroplasty Is Associated With New Persistent Opioid Use: A Retrospective Cohort Study
Stephen C. Weber, MD, San Diego, CA UNITED STATES
Eve R. Glenn, ScB, Baltimore, Maryland UNITED STATES
Alexander R. Zhu, BA, Baltimore, Maryland UNITED STATES
Henry Fox, MD, Baltimore, MD UNITED STATES
James H. Padley, BS, Baltimore, Maryland UNITED STATES
Laurence Okeke, BA, Washington, D.C. UNITED STATES
Edward G McFarland, MD, FAAOS, Baltimore, Maryland UNITED STATES
The Johns Hopkins School of Medicine, Baltimore, Maryland, UNITED STATES
FDA Status Cleared
Summary
Using the TriNetX platform, Opioid Prescriptions Following total shoulder arthroplasty was associated with new persistent opioid use
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Abstract
Introduction
Total shoulder arthroplasty (TSA) effectively relieves pain and restores function in severe osteoarthritis, but perioperative pain management remains challenging. Amid the opioid crisis, there is a shift towards opioid-sparing analgesia. This study investigates the association of 30-day postoperative opioid prescribing with outcomes such as new persistent opioid use (NPOU), mental health disorders, and follow-up duration in opioid-naive patients undergoing TSA, including both anatomic and reverse procedures.
Materials & Methods: A retrospective cohort study was conducted using the TriNetX platform, analyzing data from 127 million patients. Patients were divided into two subgroups: those who received opioids within the first month post-TSA and those who did not. Outcomes assessed included NPOU, substance use-related disorders, follow-up duration, and overall mortality, with analyses performed using propensity score matching and Kaplan-Meier survival curves.
Results
Among 22,684 TSA patients, 7,610 were in the opioid cohort and 15,074 in the non-opioid cohort. After propensity score matching, each cohort comprised 6,977 patients. During the 90-day to one-year follow-up, the opioid cohort had significantly shorter follow-up durations (P < 0.001) and higher rates of NPOU (P < 0.001) compared to the non-opioid cohort. Kaplan-Meier survival analysis showed a significantly higher cumulative incidence of NPOU in the opioid cohort (log-rank test, P < 0.001).
Conclusion
Early opioid prescribing after TSA is linked to increased NPOU and shorter follow-up durations. These findings underscore the need for careful opioid prescribing practices to balance effective pain relief with the risk of long-term dependency and other adverse outcomes.