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.