Orthopaedic surgeons frequently use opioids for peri-operative pain management and there is considerable variability in the amount prescribed between surgeons. As such, the appropriate number of opioids to prescribe for specific procedures is often unknown. Leftover prescription opioids are at risk for diversion to family and friends for nonmedical use. The aim of this study was to determine the optimal amount of narcotics to prescribe postoperatively for patients undergoing hip arthroscopy.

23 consecutive patients were enrolled. All patients were prescribed 60 tablets of hydrocodone/acetaminophen 10/325 postoperatively as part of a multimodal pain management strategy. Patients were called at 14 and 21 days post-operatively to tabulate the number of pills used and knowledge of how to properly dispose of pills.

The median number of narcotic pain pills required was 6 (IQR: 3,15). Over half of patients (56.5%) required ≤10 narcotic pain pills postoperatively. A large number of narcotic tablets (1071/1380, 77.6%) were unused and a small percentage of patients (8/23, 34.8%) were aware of proper disposal techniques. Knowledge of how to properly dispose of unused narcotics was protective against a prolonged duration of narcotic use postoperatively (Parameter estimate −5.7, 95% CI: −11.3, −0.1, p = 0.045).

Reducing the number of prescribed narcotic tablets to 25 would meet the post-operative pain demands of over 85% of hip arthroscopy patients. More judicious post-operative prescribing patterns and patient education regarding disposal may help minimize physician contribution to opioid misuse, overuse and diversion.

Recent studies have described safe outcomes for short-stays in the hospital after total shoulder arthroplasty. The purpose of this study is to identify pre-operative and operative risk factors for hospital admissions exceeding 24 hours.

The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was queried from 2006 to 2016 for the current procedural terminology (CPT) billing code related to total shoulder arthroplasty. Patients were then grouped as either having a length of stay (LOS) equal to or less than 24 hours or greater than 24 hours. Patients admitted to the hospital prior to the day of surgery were excluded. Patient demographics, co-morbidities, and operative time were then analyzed as risk factors for a hospital stay exceeding 24 hours. Pre-operative co-morbidities included body mass index (BMI), diabetes, smoking, chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), hypertension, dialysis, chronic steroid or immunosuppressant use, bleeding disorders, and American Society of Anesthesiologists (ASA) Classification. Univariate and multivariate analyses were then performed to identify risk factors associated with 30-day readmission.

14,339 patients met inclusion criteria and 6,507 (45.3%) had a hospital LOS less than or equal to 24 hours. The mean length of hospitalization was 1.95 ± 1.88 days, the average age was 69 ± 9.7 years old, and 56.9% of the patients were female. Following a risk adjusted multivariate analysis, increasing age (odds ratio [OR], 1.03, 95% confidence interval [CI], 1.02–1.03), ASA classification (OR, 1.50, 95% CI, 1.41–1.60), diabetes (OR, 1.69, 95% CI, 1.43–1.99), COPD (OR, 1.35, 95% CI, 1.16–1.57), CHF (OR, 2.67, 95% CI, 1.34–5.33), dialysis (OR, 2.47, 95% CI, 1.28, 4.77), history of a bleeding disorder (OR, 1.50, 95% CI, 1.20–1.88), or increasing operative time (OR, 1.01, 95% CI, 1.01–1.01) were identified as independent risk factors for hospital lengths of stay exceeding 24 hours. Male gender was identified as a protective factor for prolonged hospitalization (OR, 0.50, 95% CI, 0.46–0.53).

This study identifies patient demographics, co-morbidities, and operative-relative risk factors that are associated with increased risk for a prolonged hospitalization following total shoulder arthroplasty. Female gender, increasing age, ASA classification, operative time, or a history of diabetes, COPD, CHF, or history of a bleeding disorder are risk factors hospitalizations exceeding 24 hours.

Background

Rotator cuff atrophy evaluated with computed tomography scans has been associated with asymmetric glenoid wear and humeral head subluxation in glenohumeral arthritis. Magnetic resonance imaging has increased sensitivity for identifying rotator cuff pathology and has not been used to investigate this relationship. The purpose of this study was to use MRI to assess the association of rotator cuff muscle atrophy and glenoid morphology in primary glenohumeral arthritis.