Opioid-Naive Patients Have Increased New Persistent Opioid Use Following Acute Opioid Prescribing After TSA

Opioid-Naive Patients Have Increased New Persistent Opioid Use Following Acute Opioid Prescribing After TSA

Stephen C. Weber, MD, UNITED STATES Eve R. Glenn, ScB, UNITED STATES Alexander R. Zhu, BA, UNITED STATES Henry Fox, MD, UNITED STATES James H. Padley, BS, UNITED STATES Laurence Okeke, BA, UNITED STATES Edward G. McFarland, MD, FAAOS, UNITED STATES

The Johns Hopkins School of Medicine, Baltimore, Maryland, UNITED STATES


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Anatomic Location

Diagnosis / Condition

Treatment / Technique


Summary: Using the TriNetX platform, Opioid Prescriptions Following total shoulder arthroplasty was associated with new persistent opioid use


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.