Effects of socioeconomic burden on opioid use following total shoulder arthroplasty

• Published in: Journal of shoulder and elbow surgery 2024-12, Vol.33 (12), p.2596-2603
• Main Authors: Farronato, Dominic M., Pezzulo, Joshua D., Juniewicz, Robert, Rondon, Alexander J., Cox, Ryan M., Davis, Daniel E.
• Format: Article
• Language: English
• Subjects: Aged; Analgesics, Opioid - therapeutic use; Arthroplasty, Replacement, Shoulder; Female; health disparities; Humans; Male; Middle Aged; Opioid-Related Disorders - epidemiology; opioids; Pain, Postoperative - drug therapy; Patient Readmission - statistics & numerical data; Reoperation - statistics & numerical data; Retrospective Studies; reverse; Shoulder arthroplasty; Socioeconomic Factors; socioeconomic status; total
• ISSN: 1058-2746; 1532-6500; 1532-6500
• DOI: 10.1016/j.jse.2024.04.016

Preoperative opioid users experience worse outcomes and higher complication rates compared to opioid-naïve patients following shoulder arthroplasty. This study evaluates the effects of socioeconomic status, as measured by the Distressed Communities Index (DCI), on pre- and postoperative opioid use and its influence on clinical outcomes such as readmission and revision surgery. A retrospective review of patients who underwent primary shoulder arthroplasty (Current Procedural Terminology code 23472) from 2014 to 2022 at a single academic institution was performed. Exclusion criteria included arthroplasty for fracture, active malignancy, and revision arthroplasty. Demographics, Charlson Comorbidity Index, DCI, and clinical outcomes including 90-day readmission and revision surgery were collected. Patients were classified according to the DCI score of their zip code. Using the Prescription Drug Monitoring Program database, patient pre- and postoperative opioid use in morphine milligram equivalents was gathered. Individuals from distressed communities used more opioids within 90 days preoperatively compared to patients from prosperous, comfortable, mid-tier, and at-risk populations, respectively. Patients from distressed communities also used significantly more opioids within 90 days postoperatively compared with prosperous, comfortable, and mid-tier, respectively. Of patients from distressed communities, 35.1% developed prolonged opioid use (filling prescriptions >30 days after surgery), significantly more than all other cohorts. Among all patients, 3.5% were readmitted within 90 days and were more likely to be prolonged opioid users (38.9 vs. 21.3%, P