Research Summary

Higher Perioperative Opioid Use Linked to Increased Postoperative Complications after Total Shoulder Arthroplasty

Anthony Calabro, MA

Key Highlights

  • Opioid consumption after total shoulder arthroplasty was associated with increased risk of periprosthetic joint infection, fractures, and loosening.
  • Higher morphine milligram equivalents correlated with greater odds of postoperative respiratory, renal, and thromboembolic events.
  • A dose-response relationship was observed between opioid use and complication risk.

In a large retrospective study using national database data, researchers found a strong dose-dependent relationship between increased perioperative opioid use and higher rates of both surgical and medical complications following primary total shoulder arthroplasty (TSA). According to the study results, published in the Journal of Shoulder and Elbow Surgery, higher morphine milligram equivalent (MME) exposure was associated with increased risk for wound infections, periprosthetic complications, and readmissions, in addition to thromboembolic, respiratory, and renal events.

While the link between elevated opioid use and adverse outcomes after hip and knee arthroplasty is well established, limited evidence exists on its impact in the setting of shoulder replacement. This study aimed to clarify the risk posed by higher perioperative opioid exposure on short-term postoperative outcomes for those who underwent TSA.

Investigators queried the Premier Healthcare Database to identify patients who underwent primary anatomic or reverse TSA from 2016 to 2020. Perioperative opioid consumption was converted to MME and patients were stratified into quintiles of opioid exposure (< 22.3, 22.3–25, 25.01–52.5, 52.6–83.3, and > 83.3 MMEs). Primary outcomes included total opioid consumption and the incidence of 90-day postoperative complications, including revision surgery and hospital readmission. Multivariate analysis adjusted for potential confounders.

Among the 140,251 patients identified, those in higher MME quintiles were significantly younger, more frequently women, and more likely to be Black (P < .0001 for all). As opioid use increased, so did the frequency of surgical complications such as superficial wound infection, periprosthetic joint infection (PJI), periprosthetic fracture, component loosening, seroma, and unspecified mechanical issues. Similarly, medical complications including postoperative hemorrhage, pulmonary embolism, pneumonia, acute respiratory failure, acute renal failure, and urinary tract infections also rose with higher opioid doses. Patients in the highest quintile of opioid use experienced the greatest burden of both surgical and medical complications.

“Our study noted that there was a dose-dependent increase in the risk of surgical and medical complications with increasing totals of opioid perioperative opioid consumption following TSA,” the authors concluded. “Despite controlling for numerous variables, patients with increased opioid requirements in the perioperative period had increased risk of PJI, periprosthetic fracture, loosening, readmission as well as several medical complications such as pulmonary embolism, respiratory failure, and renal failure.”

Reference
Mayfield CK, Abu-Zahra M, Freshman R, et al. Perioperative opioid use in total shoulder arthroplasty is associated with dose-dependent risk of major surgical and medical complications. J Shoulder Elbow Surg. 2025;34(7):1628-1640. doi:10.1016/j.jse.2024.10.029