Does Revision Shoulder Arthroplasty Increase Your Risk of Opioid Use and Dependence

Introduction As the number of shoulder arthroplasties (SA) increased exponentially over the past two decades, so have associated complications and revision surgery rates. Pain control after revision surgery can be difficult to manage given patients are not typically opioid naive, however, to date opioid usage after revision SA has not been studied. The purpose of our study was to compare opioid use and dependence after revision SA to a primary SA cohort. Methods A retrospective review was performed of revision and primary SA patients at a single institution from 2014 to 2016. The cohort was divided into two groups: primary (n=82) and revision (n=80) shoulder arthroplasty patients. Demographics including age, sex, BMI, ASA class and smoking status were collected. Opioid consumption within 90 days of SA was collected for the preoperative and postoperative period using a state drug monitoring registry and converted to Total morphine equivalence (TME) for analyses. Opioid dependence was defined as ≥2 opioid prescriptions within 3 months. ANOVA was used to compare TME between groups and Chi square test was used for categorical variables. Logistic regression analyses were performed to determine impact of various risk factors on postoperative opioid dependence. Results Demographics were similar between the two groups for BMI (p=0.73), sex (p=0.51), smoking status (p=0.49) and ASA class (p=0.96). There was a significant difference with the revision group having an average younger age (66.0 revision, 70.1 primary; p=0.005). The mean preoperative TME was significantly higher for revision SA cohort (115.2) compared to the primary SA cohort (31.5) and postoperatively 188.7 for the revision SA cohort compared to an average of 117 for the primary cohort (p Discussion Revision shoulder arthroplasty patients have higher rates of preoperative and postoperative opioid usage and dependence when compared to primary SA. Preoperatively dependent revision patients are more likely to remain dependent in the postoperative period than primary SA patients. Orthopaedic surgeons should be aware that revision SA patients have higher opioid dependence rates and require more opioids which may indicate the need for additional consideration for risk assessments, education, and interventions when performing revision SA surgery. Level of Evidence III