Journal of Hand Surgery - June 2022 - S439

Abstract
S439
Introduction: Pain control following a total shoulder
arthroplasty (TSA) is directly related to successful
recovery and post-surgical outcomes. The current
standard of care includes the utilization of a multimodal
analgesic approach including nerve blockade,
anti-inflammatories, and breakthrough prescription
opioid medication in an effort to provide postoperative
analgesia. While this original opioid prescription
is sufficient for the majority of patients, some
patients go on to require prolonged opioid use. Our
study investigated patient risk factors associated
with opioid refill post-surgery.
Methods: Using the Truven MarketscanVR
national
insurance database, all patients who underwent a
TSA from 2010 to 2017 were included that had continuous
enrollment in the database for 6 months preoperatively
and 1 year postoperatively. Opioid data
was collected using National Drug Codes (NDC)
from outpatient pharmacy claims. Only opioid naı¨ve
patients, defined as zero opioid prescriptions filled
within 6 months preoperatively, were included.
Patients were then grouped into one of three cohorts
based on postoperative opioid use: 1) Patients with
no additional refills, 2) Patients with a minimum of
one additional refill up through 6 months postoperatively,
and 3) Patients with additional refills and
continued opioid use past 6 months. One-way
ANOVA with post-hoc comparison and multivariate
regression were run for statistical analysis. Odds
ratios with 95% confidence intervals were calculated
for variables with p value<0.05.
Results: Of the total of 17,706 opioid naı¨ve patients
that underwent a TSA, 10,882 (61.5%) did not have
any additional refills, 4,473 (25.3%) required an additional
prescription within 6 months after surgery, and
2,351 (13.3%) had prolonged opioid use beyond 6
months postoperatively. When comparing the original.
prescriptions, the prolonged use group were initially
prescribed an average 150 more OMEs than
those patients who had no refills, and nearly 100
more OMEs than those in the single refill group
(p<0.001). When OMEs is converted and standardized
to total number of 5mg oxycodone tablets, with
the prolonged use group being prescribed an average
of 20.0 more pills than the no refill group and
12.7 more than the refill group (p<0.001). On multivariate
analysis, patients older than 75 were determined
to be at half the risk of prolonged use compared
to those between 18 and 54 years old
(p<0.001). Female gender was shown to increase
odds for additional refills along with coronary
artery disease, clinical depression, tobacco use, diabetes,
and rheumatic disease. Depressed patients
were at the highest risk for prolonged opioid use
(OR 1.59, CI 1.38-1.84, p<0.001) followed by current
tobacco users (OR 1.51, CI 1.23-1.85, p<0.001).
Discussion: We observed a dose-dependent relationship
between original opioid prescription data and
number of additional refills needed, suggesting that
initially overprescribing opioids may lead to prolonged
dependency. We also found several patient
demographic factors and comorbidities associated
with prolonged use, including depression and tobacco
use. It is important to consider both medical optimization
and preoperative opioid education in these
high-risk patient populations. This study will hopefully
serve as the foundation for future studies into
opioid prescription standardization, preoperative
opioid education, and a continued move towards
opioid-free total shoulder arthroplasty.
A-2177 The Broken Scaphoid: Twenty Questions
about scaphoid fractures and nonunions
Amit Gupta, Chaitanya Mudgal, Randip Bindra and
Joseph Dias
1University of Louisville, Louisville, KYUSA
2Harvard Medical School, Harvard, MA, USA
3Gold Coast University, Gold Coast, Australia
4Leicester University, Leicester, United Kingdom
Course Description: In 1992, Nicholas Barton published
a classic article entitled " Twenty Questions
about Scaphoid Fractures " . We plan to take the
same approach and address twenty relevant contemporary
questions about scaphoid fractures in a casebased
discussion (ten in the first part and ten in the
second part of the course). We have assembled an
International faculty of experts on scaphoid fractures
and nonunions who will discuss the following questions:
1. How common are scaphoid fractures? 2.
What are the appropriate diagnostic (clinical and
radiological) algorithms for a painful injured wrist?
3. What characteristics of the scaphoid fracture point
to a bad outcome? 4. What are the options for treating
acute scaphoid fractures? 5. When is surgery
appropriate for acute nondisplaced fractures 6.
What are the available surgical approaches and
tools for treating acute scaphoid fractures? 7. What
is the current algorithm for treating acute scaphoid
fractures? 8. What are outcomes of operative and
nonoperative treatment of acute scaphoid fractures?
9. How is union defined for acute scaphoid fractures?
10. What is delayed union of the scaphoid and how
should it be managed? 11. How do you distinguish
between a dysvascular scaphoid, an avascular
scaphoid and avascular necrosis of the scaphoid?
12. How bad is nonunion of the scaphoid? 13. What
is scaphoid malunion and how should it be treated?
Journal of Hand Surgery - June 2022

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