Postoperative opioid usage is greater following hemiarthroplasty compared to reverse total shoulder arthroplasty for proximal humerus fractures

Compare postoperative opioid usage following hemiarthroplasty (HA) and reverse total shoulder arthroplasty (RTSA) for proximal humerus fracture (PHFx). Humana insurance data was reviewed for patients undergoing RTSA or HA for PHFx from 2007 through the first quarter of 2017. The incidence of postope...

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Bibliographic Details
Published in:Seminars in arthroplasty 2020-11, Vol.30 (4), p.333-339
Main Authors: Werner, Brian C., Kew, Michelle E., Brockmeier, Stephen F., Gowd, Anirudh K., Romeo, Anthony A., Agarwalla, Avinesh
Format: Article
Language:English
Subjects:
Hemiarthroplasty
Narcotics
Opioids
Reverse total shoulder arthroplasty
RTSA
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Summary:Compare postoperative opioid usage following hemiarthroplasty (HA) and reverse total shoulder arthroplasty (RTSA) for proximal humerus fracture (PHFx). Humana insurance data was reviewed for patients undergoing RTSA or HA for PHFx from 2007 through the first quarter of 2017. The incidence of postoperative opioid usage within 1 year following surgery was collected in 1-month intervals and compared between HA and RTSA patients. Baseline opioid use was also characterized. Logistic regression analysis was utilized to assess risk factors for prolonged postoperative narcotic usage. Nine hundred fourty-seven HA and 2147 RTSA were performed for PHFx. There was no difference in preoperative opioid use between both groups (RTSA: 12.4%, HA: 11.5%; P = .5). At each monthly postoperative interval, a higher proportion of patients undergoing HA utilized opioids in comparison to RTSA (P < .003 for all comparisons). The rate of postoperative opioid usage declined in both groups with 8.7% and 13.3% of RTSA and HA patients continuing to fill opioid prescriptions at 1-year postoperatively (P < .001). There was a lower proportion of patients using opioids following RTSA compared to baseline (8.7% vs. 12.4%; P< .001); however, there was no difference in narcotic usage at final follow-up in patients treated with HA (13.3% vs. 11.5%; P= .2). HA was a risk factor for prolonged opioid usage following treatment of PHFx (odds ratio = 1.65 [1.39-1.96]; P < .001). Patients undergoing HA for PHFx have a higher incidence of opioid usage up to 1-year postoperatively compared to patients undergoing RTSA for the same diagnosis. Level III
ISSN:1045-4527
1558-4437
DOI:10.1053/j.sart.2020.09.011