The Impact of Pre-Operative Benzodiazepine Use on Post-Operative Opioid Use in Total Shoulder Arthroplasty

Background As the rate of total shoulder arthroplasty (TSA) and preoperative benzodiazepine use rise, there is an increased need to understand the impact of preoperative benzodiazepine use on postoperative opioid consumption following TSA, especially amid the current opioid epidemic. The relationship between preoperative benzodiazepine use and chronic opioid use postoperatively has been well-described following other orthopedic procedures, however, the impact on patients undergoing TSA remains unclear. This study aims to identify the impact of preoperative benzodiazepine use on opioid use following TSA. Methods A retrospective chart review of 4,488 patients undergoing primary TSA (CPT code 23472) at a single institution from 2014-2022 was performed. Patient demographics, surgical variables, comorbidities, distressed communities index score (DCI), and clinical outcomes, including readmission and revision, were collected. The Charlson Comorbidity Index (CCI) was used to assess preoperative health status. Opioid use in morphine milligram equivalents (MME) and benzodiazepine use were also recorded using the Prescription Drug Monitoring Program Database. Opioid use was collected at 30-, 60-, and 90-day intervals both before and after each patient’s date of surgery. Statistical analysis included stepwise logistic regression to identify variables independently affecting benzodiazepine use pre- and postoperatively. Results Overall, 16% of patients utilized benzodiazepines within 90 days before their date of surgery. Of those patients, 46.4% were also utilizing preoperative opioids, compared to just 30.0% of patients who were benzodiazepine-naïve (p<0.001). Preoperative benzodiazepine use was also associated with increased pre- and postoperative total opioid use in MME and the number of opioid prescriptions across all time points when compared to benzodiazepine-naïve patients (p<0.001). Furthermore, 37.4% of preoperative benzodiazepine users went on to prolonged opioid use (filled prescriptions >30 days after surgery) compared to 19.0% of those who were benzodiazepine-naïve (p<0.001). Conclusion This study demonstrates a significant association between preoperative benzodiazepine use and increased and prolonged opioid use following TSA. Further exploration of risk factors contributing to preoperative benzodiazepine use may help to reduce overall opioid use in patients undergoing TSA.