Retrospective Cohort Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Aug 18, 2018; 9(8): 105-111
Published online Aug 18, 2018. doi: 10.5312/wjo.v9.i8.105
Effect of opioid dependence or abuse on opioid utilization after shoulder arthroplasty
Derek D Berglund, Samuel Rosas, Jennifer Kurowicki, Dragomir Mijic, Jonathan C Levy
Derek D Berglund, Samuel Rosas, Jennifer Kurowicki, Dragomir Mijic, Jonathan C Levy, Department of Orthopedic Surgery, Holy Cross Orthopedic Institute, Fort Lauderdale, FL 33334, United States
Samuel Rosas, Department of Orthopedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC 27157-1070, United States
Jennifer Kurowicki, Department of Orthopaedic Surgery, Seton Hall University School of Health and Medical Sciences, South Orange, NJ 07079, United States
Author contributions: Berglund DD, Rosas S, Kurowicki J, Mijic D and Levy JC contributed significantly towards project design, analysis, and manuscript writing/editing.
Institutional review board statement: This study has been determined exempt from Institutional Review Board (IRB) review by the Holy Cross Hospital Research Office.
Informed consent statement: As this study utilizes publicly available data from a nationwide database, informed consent was not obtained from individual subjects included in the study. Study data contained no patient identifiers and cannot be linked to an individual patient.
Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Jonathan C Levy, MD, Staff Physician, Surgeon, Chief of Orthopedics, Department of Orthopedic Surgery, Holy Cross Orthopedic Institute, 5597 North Dixie Highway, Fort Lauderdale, FL 33334, United States. jonlevy123@yahoo.com
Telephone: +1-954-4894579 Fax: +1-954-2298698
Received: March 5, 2018
Peer-review started: March 6, 2018
First decision: March 23, 2018
Revised: May 17, 2018
Accepted: May 23, 2018
Article in press: May 23, 2018
Published online: August 18, 2018
Processing time: 167 Days and 14.6 Hours
Abstract
AIM

To examine whether opioid dependence or abuse has an effect on opioid utilization after anatomic or reverse total shoulder arthroplasty (TSA).

METHODS

All anatomic TSA (ICD-9 81.80) and reverse shoulder arthroplasty (RSA) (ICD-9 81.88) procedures from 2007 to 2015 were queried from within the Humana claims database utilizing the PearlDiver supercomputer (Colorado Springs, CO). Study groups were formed based on the presence or absence of a previous history of opioid dependence (ICD-9 304.00 and 304.03) or abuse (ICD-9 305.50 and 305.53). Opioid utilization among the groups was tracked monthly up to 1 year post-operatively utilizing National Drug Codes. A secondary analysis was performed to determine risk factors for pre-operative opioid dependence or abuse.

RESULTS

Two percent of TSA (157 out of 7838) and 3% of RSA (206 out of 6920) patients had a history of opioid dependence or abuse. For both TSA and RSA, opioid utilization was significantly higher in opioid dependent patients at all post-operative intervals (P < 0.01) although the incidence of opioid use among groups was similar within the first post-operative month. After TSA, opioid dependent patients were over twice as likely to fill opioid prescriptions during the post-operative months 1-12. Following RSA, opioid dependent patients were over 3 times as likely to utilize opioids from months 3-12. Age less than 65 years, history of mood disorder, and history of chronic pain were significant risk factors for pre-operative opioid dependence/abuse in patients who underwent TSA or RSA.

CONCLUSION

Following shoulder arthroplasty, opioid use between opioid-dependent and non-dependent patients is similar within the first post-operative month but is greater among opioid-dependent patients from months 2-12.

Keywords: Opioid; Narcotic; Abuse; Dependence; Anatomic total shoulder arthroplasty; Reverse shoulder arthroplasty; Chronic pain; Mood disorder

Core tip: A retrospective analysis of the Humana claims determined that patients with pre-operative opioid dependence or abuse had higher post-operative opioid utilization after anatomic total shoulder arthroplasty and reverse shoulder arthroplasty. Younger age, mood disorders, and chronic pain diagnoses were significant risk factors for pre-operative opioid dependence or abuse.