These authors sought to determine baseline opioid use in patients undergoing shoulder arthroplasty and identify patient characteristics, comorbidities, and surgical risk factors associated with postoperative opioid use in 3996 patients from a shoulder arthroplasty registry. They identified the number of dispensed opioid medication prescriptions in each quarter of the first postoperative year.
The factors associated with increased opioid use were age <60 years, the amount of preoperative opioid use, anxiety, opioid dependence, substance abuse, and general chronic pain.
During the 1-year preoperative period, 75% of the patients used opioids (range, 1-79 prescriptions). Postoperatively, 92.6% used opioids in the early recovery period, and 38% to 42% used opioids in the later rehabilitation period, 39% at 1 year postoperatively
Depression was the most common opioid use-related comorbidity.
Comment: Like the authors, we are very concerned about the widespread use of narcotics. Preoperatively, we try to set the expectation that patients would be off narcotics within two weeks of surgery. For patients taking narcotics and seeking, we ask that they make substantial progress in reducing their dependency before scheduling surgery, explaining that the less narcotic medication they're taking before surgery, the less problem we'll have in managing their pain after surgery. We are reluctant to perform elective surgery on patients taking substantial doses of narcotics or long-term narcotics, such as Oxycontin, or MScontin.
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