Abstract：
BACKGROUND: As the rate of total shoulder arthroplasty (TSA) and preoperative benzodiazepine use rise, there is an increased need to understand the impact of preoperative benzodiazepine use on postoperative opioid consumption following TSA, especially amid the current opioid epidemic. The relationship between preoperative benzodiazepine use and chronic opioid use postoperatively has been well described following other orthopedic procedures; however, the impact on patients undergoing TSA remains unclear. This study aims to identify the impact of preoperative benzodiazepine use on opioid use following TSA.
METHODS: A retrospective chart review of 4488 patients undergoing primary TSA (Current Procedural Terminology code 23472) at a single institution from 2014 to 2022 was performed. Patient demographics, surgical variables, comorbidities, Distressed Communities Index (DCI), and clinical outcomes, including readmission and revision, were collected. The Charlson Comorbidity Index (CCI) was used to assess preoperative health status. Opioid use in morphine milligram equivalents (MMEs) and benzodiazepine use were also recorded using the Prescription Drug Monitoring Program Database. Opioid use was collected at 30-, 60-, and 90-day intervals both before and after each patient\'s date of surgery. Statistical analysis included stepwise logistic regression to identify variables independently affecting benzodiazepine use pre- and postoperatively.
RESULTS: Overall, 16% of patients used benzodiazepines within 90 days before their date of surgery. Of those patients, 46.4% were also using preoperative opioids, compared with just 30.0% of patients who were benzodiazepine-naïve (P < .001). Preoperative benzodiazepine use was also associated with increased pre- and postoperative total opioid use in MMEs and the number of opioid prescriptions across all time points when compared to benzodiazepine-naïve patients (P < .001). Furthermore, 37.4% of preoperative benzodiazepine users went on to prolonged opioid use (filled prescriptions >30 days after surgery) compared to 19.0% of those who were benzodiazepine-naïve (P < .001).
CONCLUSIONS: This study demonstrates a significant association between preoperative benzodiazepine use and increased and prolonged opioid use following TSA. Further exploration of risk factors contributing to preoperative benzodiazepine use may help to reduce overall opioid use in patients undergoing TSA.
METHODS: A retrospective chart review of 4488 patients undergoing primary TSA (Current Procedural Terminology code 23472) at a single institution from 2014 to 2022 was performed. Patient demographics, surgical variables, comorbidities, Distressed Communities Index (DCI), and clinical outcomes, including readmission and revision, were collected. The Charlson Comorbidity Index (CCI) was used to assess preoperative health status. Opioid use in morphine milligram equivalents (MMEs) and benzodiazepine use were also recorded using the Prescription Drug Monitoring Program Database. Opioid use was collected at 30-, 60-, and 90-day intervals both before and after each patient\'s date of surgery. Statistical analysis included stepwise logistic regression to identify variables independently affecting benzodiazepine use pre- and postoperatively.
RESULTS: Overall, 16% of patients used benzodiazepines within 90 days before their date of surgery. Of those patients, 46.4% were also using preoperative opioids, compared with just 30.0% of patients who were benzodiazepine-naïve (P < .001). Preoperative benzodiazepine use was also associated with increased pre- and postoperative total opioid use in MMEs and the number of opioid prescriptions across all time points when compared to benzodiazepine-naïve patients (P < .001). Furthermore, 37.4% of preoperative benzodiazepine users went on to prolonged opioid use (filled prescriptions >30 days after surgery) compared to 19.0% of those who were benzodiazepine-naïve (P < .001).
CONCLUSIONS: This study demonstrates a significant association between preoperative benzodiazepine use and increased and prolonged opioid use following TSA. Further exploration of risk factors contributing to preoperative benzodiazepine use may help to reduce overall opioid use in patients undergoing TSA.
摘要：
背景：随着全肩关节置换术（TSA）和术前使用苯二氮卓类药物的比率上升，越来越需要了解术前使用苯二氮卓类药物对TSA术后阿片类药物消耗的影响，尤其是在当前阿片类药物流行的情况下。术前使用苯二氮卓类药物与术后长期使用阿片类药物之间的关系已经在其他骨科手术后得到了很好的描述，然而,对接受TSA的患者的影响尚不清楚.本研究旨在确定术前使用苯二氮卓类药物对TSA后阿片类药物使用的影响。
方法：对2014-2022年在单一机构接受原发性TSA（CPT代码23472）的4,488例患者进行回顾性图表回顾。患者人口统计学，手术变量，合并症,困境社区指数得分(DCI)，和临床结果，包括重新接纳和修订，被收集。Charlson合并症指数（CCI）用于评估术前健康状况。阿片类药物在吗啡毫克当量（MME）中的使用和苯二氮卓的使用也使用处方药监测计划数据库记录。阿片类药物的使用是在30-收集的，60-,以及每个患者手术日期之前和之后的90天间隔。统计分析包括逐步逻辑回归，以确定独立影响术前和术后使用苯二氮卓类药物的变量。
结果：总体而言，16%的患者在手术日期前90天内使用苯二氮卓类药物。这些病人中,46.4%的人也使用术前阿片类药物，相比之下，只有30.0%的患者是苯二氮卓-初治（p<0.001）。术前使用苯二氮卓类药物也与MME的术前和术后总阿片类药物使用增加以及所有时间点的阿片类药物处方数量相关（p<0.001）。此外，37.4％的术前苯二氮卓类药物使用者继续长期使用阿片类药物（术后30天以上的处方），而19.0％的人是苯二氮卓类药物（p<0.001）。
结论：这项研究表明，术前使用苯二氮卓类药物与TSA后阿片类药物使用增加和延长之间存在显著关联。进一步探索导致术前使用苯二氮卓类药物的危险因素可能有助于减少TSA患者的整体阿片类药物使用。
方法：对2014-2022年在单一机构接受原发性TSA（CPT代码23472）的4,488例患者进行回顾性图表回顾。患者人口统计学，手术变量，合并症,困境社区指数得分(DCI)，和临床结果，包括重新接纳和修订，被收集。Charlson合并症指数（CCI）用于评估术前健康状况。阿片类药物在吗啡毫克当量（MME）中的使用和苯二氮卓的使用也使用处方药监测计划数据库记录。阿片类药物的使用是在30-收集的，60-,以及每个患者手术日期之前和之后的90天间隔。统计分析包括逐步逻辑回归，以确定独立影响术前和术后使用苯二氮卓类药物的变量。
结果：总体而言，16%的患者在手术日期前90天内使用苯二氮卓类药物。这些病人中,46.4%的人也使用术前阿片类药物，相比之下，只有30.0%的患者是苯二氮卓-初治（p<0.001）。术前使用苯二氮卓类药物也与MME的术前和术后总阿片类药物使用增加以及所有时间点的阿片类药物处方数量相关（p<0.001）。此外，37.4％的术前苯二氮卓类药物使用者继续长期使用阿片类药物（术后30天以上的处方），而19.0％的人是苯二氮卓类药物（p<0.001）。
结论：这项研究表明，术前使用苯二氮卓类药物与TSA后阿片类药物使用增加和延长之间存在显著关联。进一步探索导致术前使用苯二氮卓类药物的危险因素可能有助于减少TSA患者的整体阿片类药物使用。
