The relationship between preoperative opioid use and adverse events following total shoulder arthroplasty

Introduction: Few studies have analyzed the effect of preoperative opioid use on postoperative outcomes after total shoulder arthroplasty (TSA). Methods: Patients undergoing TSA were identified in the Pearldiver Humana Claims Dataset and stratified by level of preoperative opioid use. Primary outcomes were 90-day complications, readmissions, and revision surgery. Chi-square test and ANOVA were used to evaluate categorical and continuous variables respectively. A multivariable logistic regression analysis and a sub analysis excluding fracture as a primary diagnosis were completed. Results: 18,791 patients underwent aTSA and rTSA including 9933 opioid naïve patients, 3016 sporadic opioid users and 5842 persistent opioid users. Significant differences were found in complications (6.0% vs 6.1% vs 9.1%, p <.001), readmission (7.6% vs 8.2% vs 12.6%, p <.001), and revision procedures (1.1% vs 1.1% vs 2.3%, p <.001) which remained significant after excluding fractures. After adjusting for comorbidity burden, persistent opioid use was associated with increased likelihood of complications (OR 1.4, 1.2–1.6), readmission (OR 1.6, 1.5–1.8) and revision procedures (OR 1.9, 1.5–2.4). This association remained after excluding fractures. Conclusion: Persistent preoperative opioid use is associated with increased risk of early postoperative complications, readmission, and revision surgery for patients undergoing shoulder arthroplasty.