Abstract：
BACKGROUND: 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.
METHODS: 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.
RESULTS: 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 < .001). Similarly, 1.5% of patients underwent revision surgery. Those who underwent revision were significantly more likely to be prolonged opioid users (38.2 vs. 21.7%, P = .002).
CONCLUSIONS: Shoulder arthroplasty patients from distressed communities use more opioids within 90 days before and after their surgery and are more likely to become prolonged opioid users, placing them at risk for readmission and revision surgery. Identifying patients at an increased risk for excess opioid use is essential to employ appropriate strategies that minimize the detrimental effects of prolonged use following surgery.
METHODS: 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.
RESULTS: 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 < .001). Similarly, 1.5% of patients underwent revision surgery. Those who underwent revision were significantly more likely to be prolonged opioid users (38.2 vs. 21.7%, P = .002).
CONCLUSIONS: Shoulder arthroplasty patients from distressed communities use more opioids within 90 days before and after their surgery and are more likely to become prolonged opioid users, placing them at risk for readmission and revision surgery. Identifying patients at an increased risk for excess opioid use is essential to employ appropriate strategies that minimize the detrimental effects of prolonged use following surgery.
摘要：
背景：术前阿片类药物使用者（POU）在肩关节置换术后，与阿片类药物初治患者（ONP）相比，其预后更差，并发症发生率更高。这项研究评估了社会经济地位(SES)的影响，以贫困社区指数(DCI)衡量，术前和术后阿片类药物的使用及其对临床结局的影响，如再入院和翻修手术。
方法：对2014-2022年在单一学术机构接受初次肩关节置换术（CPT代码23472）的患者进行回顾性分析。排除标准包括骨折关节成形术，活动性恶性肿瘤，和翻修关节成形术。人口统计,Charlson合并症指数（CCI），收集DCI和临床结果，包括90天的再入院和翻修手术。根据邮政编码的DCI评分对患者进行分类。使用处方药监测计划数据库，收集患者术前和术后阿片类药物的使用情况,即吗啡毫克当量(MME).
结果：与富裕地区的患者相比，不良社区的患者在术前90天内使用了更多的阿片类药物，舒适,中端,分别为高危人群。与繁荣相比，来自困境社区的患者在术后90天内也使用了更多的阿片类药物，舒适,和中端分别。来自贫困社区的病人，35.1%的人长期使用阿片类药物（手术后服用处方>30天），明显超过所有其他队列。在所有患者中，3.5％的人在90天内重新入院，并且更有可能长期使用阿片类药物（38.9％vs21.3％，p<0.001)。同样，1.5%的患者进行了翻修手术。那些接受过修订的人更有可能是长期使用阿片类药物的人(38.2%vs21.7%，p=0.002)。
结论：来自贫困社区的肩关节置换术患者在手术前后90天内使用更多阿片类药物，并且更有可能成为长期阿片类药物使用者，使他们面临再次入院和翻修手术的风险。确定过量使用阿片类药物的风险增加的患者对于采用适当的策略以最大程度地减少手术后长期使用的有害影响至关重要。
方法：对2014-2022年在单一学术机构接受初次肩关节置换术（CPT代码23472）的患者进行回顾性分析。排除标准包括骨折关节成形术，活动性恶性肿瘤，和翻修关节成形术。人口统计,Charlson合并症指数（CCI），收集DCI和临床结果，包括90天的再入院和翻修手术。根据邮政编码的DCI评分对患者进行分类。使用处方药监测计划数据库，收集患者术前和术后阿片类药物的使用情况,即吗啡毫克当量(MME).
结果：与富裕地区的患者相比，不良社区的患者在术前90天内使用了更多的阿片类药物，舒适,中端,分别为高危人群。与繁荣相比，来自困境社区的患者在术后90天内也使用了更多的阿片类药物，舒适,和中端分别。来自贫困社区的病人，35.1%的人长期使用阿片类药物（手术后服用处方>30天），明显超过所有其他队列。在所有患者中，3.5％的人在90天内重新入院，并且更有可能长期使用阿片类药物（38.9％vs21.3％，p<0.001)。同样，1.5%的患者进行了翻修手术。那些接受过修订的人更有可能是长期使用阿片类药物的人(38.2%vs21.7%，p=0.002)。
结论：来自贫困社区的肩关节置换术患者在手术前后90天内使用更多阿片类药物，并且更有可能成为长期阿片类药物使用者，使他们面临再次入院和翻修手术的风险。确定过量使用阿片类药物的风险增加的患者对于采用适当的策略以最大程度地减少手术后长期使用的有害影响至关重要。
