Opioid prescriptions after total shoulder arthroplasty are associated with new persistent opioid use: a retrospective cohort study

Background Pain management after total shoulder arthroplasty (TSA) can be challenging. We examined the association between early postoperative opioid prescribing and postoperative (up to 1 year) outcomes of new persistent opioid use (NPOU), nonopioid substance use disorders, depressive episodes, and all-cause mortality among previously opioid-naive TSA patients. We hypothesized that early opioid prescribing would be associated with higher NPOU and differences in follow-up duration. Methods This retrospective study of 22,684 patients used the TriNetX Research Network database. Patients underwent TSA between July 31, 2004, and July 31, 2024, and were categorized into 2 cohorts: 1) those who received at least 1 opioid prescription within 30 days after TSA (opioid cohort, n = 7610) and 2) those who did not receive an opioid prescription during that period (nonopioid cohort, n = 15,074). Outcomes assessed between 90 days and 1 year after TSA were NPOU, nonopioid substance use disorders, depressive episodes, and all-cause mortality. Analyses were performed using propensity score matching and Kaplan-Meier survival curves. After matching, each cohort comprised 6977 patients. Alpha = .05. Results Mean follow-up duration was 261 ± 141 days. After matching, the opioid cohort had a higher incidence of NPOU (10%) than the nonopioid cohort (7.7%) ( P < .001), corresponding to a risk difference of 2.3% and a relative risk of 1.3. The opioid cohort had a lower incidence of nonopioid substance use disorders (1.2%) than the nonopioid cohort (1.6%) ( P = .04), with no differences in depressive episodes ( P = .82) or all-cause mortality ( P = .74). Conclusion In previously opioid-naive patients undergoing TSA, early postoperative opioid prescribing was associated with greater risk of NPOU, whereas no differences were observed in depressive episodes or all-cause mortality. A lower incidence of nonopioid substance use disorders was seen in the opioid cohort. These findings underscore the need for tailored, multimodal pain management strategies after TSA. Level of evidence III