Table 1.
Characteristics of included studies.
| Study | Year | Study design | Level of evidence | Country | MINORS score | Age, mean ± SD | Sample size | Sex (female%) | BMI | Comorbid Conditions | Diagnosis | Operative Procedure | Follow-up preiod |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Morris et al. | 2015 | Retrospective cohort study | III | US | 19 | 68.5 ± 9.5 | 68 | 39 (57.3) | 28.3 ± 7.35 | No differences were found between the preoperative opioid group and the nonopioid group in smoking status, BMI, history of chronic back pain, depression, diabetes, or heart disease. | Rotator cuff arthropathy | rTSA | 3.14 ± 1.7 |
| Morris et al. | 2016 | Retrospective cohort study | III | US | 18 | 66.5 ± 9.5 | 224 | 78 (34.8) | 30.5 ± 6.0 | No statistical differences were noted between the preoperative opioid group and the nonopioid group regarding diabetes, and heart disease, Patients with preoperative opioid use had a significantly higher prevalence of chronic back pain (52% vs. 30%; P = 0.003) and depression (13% vs. 4%; P = 0.04) and higher BMI (32 ± 7 kg/m2 vs. 29 ± 5 kg/m2; P = 0.01). | Glenohumeral joint osteoarthritis | aTSA | 3.3 ± 1.2 |
| Cuff et al. | 2016 | Prognostic case series | IV | US | 12 | 63.3 years (range, 22 to 77 years) | 181 | 79 (44) | NR | NR | Partial- or full-thickness rotator cuff tear | Arthroscopic rotator cuff surgery along with subacromial decompression | NR |
| Cheah et al. | 2017 | Retrospective cohort study | III | US | 19 | 67.3 | 262 | 139 (53) | Opioid group had a significantly greater number of patients with a BMI greater than or equal to 30 compared with the non–opioid user cohort (P = 0.016). | All other characteristics were similar, with a noted trend that the opioid cohort had a slightly higher Charlson Comorbidity Index (P = 0.057) | NR | 170 rTSA and 92 aTSA | 2 years |
| Berglund et al. | 2018 | Retrospective cohort study | III | US | 11 | 71 years (range, 30 to 90 years) | 490 | NR | NR | NR | OA without RCT, OA with RCT, Fracture sequelae, Avascular necrosis, Failed arthroplasty, Locked dislocation and Inflammatory arthritis | HA, aTSA, rTSA | 47 months; range, 24 to 124 months |
| Grace et al. | 2018 | Retrospective analysis of prospective cohort study | II | US | 21 | median age was 68 years (range, 29–89 years) | 119 | 56 (47.1) | 30.1 ± 5.4 | There was no significant difference in prevalence of depression (8.5% vs 5.6%, P = 0.53). | Osteoarthritis, Avascular necrosis, Proximal humeral fracture, Rotator cuff arthropathy | aTSA (37.0%), rTSA (63.0%). | NR |
| Menendez et al. | 2018 | Retrospective analysis of prospective cohort study | II | US | 21 | 69 ± 8 | 415 | 253 (61) | 30.8 ± 6.3 | Patients reporting severe postoperative pain were more likely to have more self-reported allergies (3.4 vs. 1.5, P < 0.001), diabetes (22% vs. 11%, P = 0.005), comorbid diagnosis of major depression (37% vs. 21%, P = 0.001), and an ASA score ≥ III (30% vs. 20%, P = 0.031). The most prevalent comorbidities were hypertension (60%), hypercholesterolemia (39%), and depression (25%). | osteoarthritis (69), rotator cuff arthropathy (22) | aTSA (29%), rTSA (71%) | NR |
| Rao et al. | 2018 | Retrospective cohort study | III | US | 12 | 84.1% (n = 3570) were aged ≥60 years | 3996 | 2201 (51.9) | 57.0% (n = 2176) had a BMI < 30 | Hypertension was the most prevalent medical comorbidity (n = 2574 [69.0%]), and depression was the most common opioid use-related comorbidity (n = 604 [17.2%]) | NR | Hemiarthroplasty/humeral head resurfacing 891 (21.0%), rTSA 923 (21.8%), aTSA 2429 (57.2%) | minimum of 1 year |
| Thompson et al. | 2019 | Retrospective cohort study | III | US | 18 | 61.0 ± 11.8 | 73 | 36 (49.3) | 32.2 ± 6.2 | No significant differences were noted between the groups with respect comorbidities including DM, smoking, chronic pain syndromes, or mood disorders (including depression and anxiety). | primary glenohumeral osteoarthritis | aTSA | 32.8 ± 10.3 months |
| Brock et al. | 2019 | Retrospective cohort study | III | US | 21 | 69.0 ± 8.6 | 22,524 | 10,170 (45.5) | NR | Depression increased the risk for chronic postoperative opioid use, as did intravenous drug use for RCR but not TSA. Smoking and chronic lung disease were not significant predictors. | diagnosis codes used for TSA and RCR | TSA and rotator cuff repair | NR |
| Curtis et al. | 2019 | Retrospective cohort study | III | US | 22 | 67.55 ± 11.15 | 138 | 73 (52.9) | NR | The opioid cohort included five patients with a medical history of myocardial infarction (versus 1 control subject; P = 0.014) and three with peptic ulcer disease (versus 0 control subject; P = 0.057). Differences between cohorts in all other comorbidities, were not statistically significant. | Osteoarthritis, Rotator cuff arthropathy, Chronic dislocation, fractures, AVN, Osteomyelitis, Periprosthetic infection, and Arthroplasty failure. | TSAs (69.1% reverse and 30.9% anatomic). | 393 ± 299 days |
| Mayer et al. | 2019 | Prognostic case-control study | III | US | 21 | 61.9 | 152 | 67 (44.0) | 33.7 | The chronic narcotic-use group had significantly more smokers than the non-narcotic group (P = 0.002); there were no other significant differences in comorbidities between groups. These comorbidities include: Asthma, COPD, Heart disease, HTN, DM, Depression/anxiety, OSA, and Kidney disease. | Osteoarthritis | aTSA | NR |
| Williams et al. | 2019 | Retrospective cohort study | III | US | 19 | 58.4 ± 10.1 | 200 | 96 (48.0) | 30.6 ± 6.1 | Notable statistically significant differences between groups included increased frequencies of back pain, depression, use of antidepressants or anxiolytics, or both, and degenerative joint disease in the preoperative opioid group. | Full-thickness or partial-thickness tears of the supraspinatus tendon | Arthroscopic Rotator Cuff Repair | 47.2 (15.1) |
| Khazi et al. | 2019 | Retrospective cohort study | III | US | 20 | Age < 25 yr = 2045 (42.6) | 4802 | 1384 (28.82) | BMI ≥ 30 kg/m2 = 346 (7.21) | 5.5% (n = 266) had a diagnosis of depression or anxiety, 7.1% (n = 339) had a diagnosis of fibromyalgia, and 0.3% (n = 15) had a diagnosis of Ehlers-Danlos syndrome | Shoulder instability | 4268 (88.9%) underwent arthroscopic stabilization; 298 (6.2%), open Bankart procedures; 114 (2.4%), Latarjet procedures; and 122 (2.5%), other open procedures | minimum of 1 year |
| Kolade et al. | 2020 | Retrospective cohort study | III | US | 13 | 68.6 ± 10.1 | 622 | 368 (59.5) | BMI was reported within bivariate analysis of average MME by patient characteristics for TSA patients with no differences between groups | Psychiatric disorders 217 (35); ASA II to IV 610 (98.1); Prior shoulder surgery 382 (62). | NR | rTSA (56%); TSA (43%); Revision rTSA (1.28%); Revision TSA (0.16%). | |
| Best et al. | 2020 | Prospective cohort study | II | US | 12 | 57 ± 5.6 | 5621 | 2375 (42) | NR | Charlson comorbidity index 0.33 ± 0.68 | NR | Primary TSA | NR |
| Sabesan et al. | 2020 | Retrospective cohort study | III | US | 18 | 68.1 ± 9.4 | 162 | 94 (58) | 30.2 ± 6.3 | ASA class II to IV, 11.7% smokers | NR | 60 aTSA; 22 rTSA (group 1) and 80 revision TSA patients (all had a revision to Reversed) (group 2). | |
| Jildeh et al. | 2020 | Retrospective cohort study | III | US | 19 | 26.3 ± 11.7 | 340 | 85 (25) | 27.5 ± 5.4 | NR | Biceps tenodesis 12 (3.5); SLAP tear 105 (30.9); ALPSA, GLAD, or HAGL 13 (3.8); Bankart lesion 242 (71.2); Hill-Sachs lesion 150 (44.1); Reverse Hill-Sachs lesion 9 (2.6); Instability events 21 (97.3). | Shoulder arthroscopy with capsulorrhaphy including Bankart repair, arthroscopic SLAP repair, and limited arthroscopic debridement. | |
| Peratikos et al. | 2020 | Retrospective cohort study | III | US | 21 | 61 (57 to 64) | 1387 | 550 (40) | NR | Charlson comorbidity index, median (IQR) 0 (0 to 1); Severe comorbidity 47 (3); History of mood or anxiety disorder 398 (29); History of substance use disorder 82 (6), History of personality or trauma and stressor disorder 38 (3); History of tobacco use 232 (17) | NR | TSA | NR |
| Lu et al. | 2020 | Retrospective cohort study | III | US | 21 | 56.82 ± 11.36 | 1242 | 505 (40.6) | 31.06 ± 7.38 | Depression 137 (11.0), Diabetes 113 (9.1), Heart disease 51 (4.1), Hypertension 313 (25.2), Degenerative joint disease 274 (18.1), Alcohol abuse 44, Smoking history 105 (6.5). | NR | Rotator cuff repair 298 (24.0); SLAP repair 25 (2.0); Capsulorraphy 102 (8.2); Biceps tenodesis 37 (3.0); Subacromial decompression 430 (34.6); Extensive debridement 220 (17.7); Limited debridement 130 (10.5). | minimum of 1 year |
| Farley et al. | 2020 | Retrospective cohort study | III | US | 20 | While statistically different, patient age breakdown was overall clinically similar among groups without an obvious trend. | 214,283 | 92,123 (43.0) | NR | Significant differences in every examined comorbidity at baseline although small, they were universally higher in the high opioid use groups (P < 0.001 for all comparisons). These include: Obesity, Chronic kidney disease, Alcohol use disorder, Tobacco use, Hypertension, Coronary artery disease, Congestive heart failure, Hyperlipidemia, Rheumatic disease, Diabetes, Depression. | NR | Arthroscopic Rotator Cuff Repair ± biceps tenodesis, subacromial decompression, distal clavicle resection, these were overall similar between groups. | NR |