Can We Predict Narcotic Dependence Following Total Shoulder - - PowerPoint PPT Presentation

Can We Predict Narcotic Dependence Following Total Shoulder Arthroplasty?

Kiran Chatha, MD; Lucas Goss; Wilfredo Borroto; Jesus Villa, MD; Vani Sabesan, MD

Cleveland Clinic Florida Levitetz Department of Orthopedic Surgery

Introduction

We Are Facing an Undeniable Narcotic Use Crisis in the US

• The United States Consumes 85% of the World’s Oxycodone and 95%
• f the World’s Hydrocodone
• In 2015 Alone: 15,000 Overdose Deaths from Narcotic Use
• In 2014: Approx. 2,000,000 Americans were Dependent or Abusing

Narcotics

Why Is This Important?

Orthopedic Surgeons are the 3rd Largest Prescribers of Narcotics

As Surgeons We Need to Examine What Factors About Our Specific Patient Population We Can Influence

Arthritis Management

Conservative Management of Arthritis by Primary Care is Usually with NSAIDs and Narcotics Specifically Chronic Shoulder Arthritis Patients Have High Rates of Narcotic Dependence Because of Chronic Use Leading Up To Surgery Theoretically, Relieving Arthritic Pain Through Surgery Should Result in Decreased Narcotic Use Postoperatively

Purpose

To Determine Risk Factors for Postoperative Narcotic Dependence Among Shoulder Arthritis Patients Undergoing TSA

Methods

Retrospective Case-control Study 747 TSA patients were included (2012-2015)

• Preoperatively Dependent: Cases
• Preoperatively Naïve: Controls

All Recorded Prescriptions In Epic Were Examined and Correlated with the Automated State Databases

Definitions

• Preoperative and Postoperative Dependence Was Defined As

Continued Narcotic Use for 3 Months Surrounding Surgery

• Preoperative and Postoperative Narcotic Use Was Defined As

Recorded Narcotic Prescriptions For At Least 1 Month Prior to or After Surgery

Results – Preoperative Consumption

• 747 Cases Included

229 295 100 200 300 400 500 600 Dependent Non Dependent

Preoperative Narcotic Exposure Status

Exposed Naïve

223

• Postoperatively Dependent: 32% (240/747)
• 46% (341/747) Were Able to Wean off Narcotics by 30 Days
• 53% (393/747) of Patients Received At Least 1 Refill
• 69% from Orthopedic Surgeons
• 36% (141/393) Received Refills For More Than 30 Days

Postoperative Consumption

Preoperatively Narcotic Naïve

• 518 Patients Preoperatively Naive

46% 54%

Narcotic Use at 1 Month

Narcotic Use Weaned off of Narcotics

26% 74%

Narcotic Dependence at 3 Months

Narcotic Dependent Weaned off of Narcotics

12% Remained Narcotic Dependent at 6 Months after Surgery!

• 229 Patients Preoperatively Dependent

Preoperatively Narcotic Dependent

47% 53%

Narcotic Dependence at 3 Months

Narcotic Dependent Weaned off of Narcotics

73% 27%

Narcotic Use at 1 Month

Narcotic Use Weaned off of Narcotics

22% were still On Narcotics At 6 Months Postoperatively!

Consumption Patterns in Postoperatively Dependent Patients

• Amount Of Narcotics Prescribed Postoperatively:
• Narcotic Naïve Preoperatively: 423 MMEs per script
• Narcotic Dependent Preoperatively: 448 MMEs per script

Risk of Postoperative Dependence

• Odds Ratio Calculations Showed a Statistically Significant

3.5 Times Risk of Narcotic Dependence Postoperatively if Patients Were Narcotic Dependent Preoperatively

Conclusions

• The Vast Majority of Narcotic Naïve Patients Are Able To Wean Off By 90 Days

Postoperatively

• There was a 3.5 times risk of dependence at 90 days if you had preoperative narcotic

dependence

• Of The Patients Receiving Refills, 69% Were Receiving Refills From Their

Orthopedist

• As Surgeons, it is Important to be Aware of this Trend to Avoid Overprescribing and

Creating Further Narcotic Dependence

So… Can We Predict Narcotic Dependence Following TSA?

YES!

It appears that preoperative dependence can predict narcotic dependence postoperatively

Thank you!