Table 1.
Pain and opioid use.
| Level of evidence | Author(s) | Journal | Number of patients, mean age (years) | Type of arthroplasty | Pertinent findings |
|---|---|---|---|---|---|
| III | Best et al 11 (2021) | Orthopedics | 5676 (57) | Anatomic TSA | Smokers had significantly increased postoperative opioid dependence (OR, 1.3 [95% CI, 1.0–1.7], p = .034). |
| III | Kolade et al 12 (2020) | Journal of Shoulder and Elbow Surgery | 622 (68) | Anatomic TSA & reverse TSA | Inpatient opioid consumption was measured in morphine milligram equivalents (MME). Active smokers had higher MME compared to never smokers (38.2 and 24.9, respectively; p = .021). Former smokers had MME of 31.6 (p = .3) when compared to active smokers. Expected decrease in inpatient opioid use postoperatively was lower in active smokers than former smokers (p = .03) and never smokers (p = .01). Longer duration of smoking (more pack-years) showed lower reduction of opioid consumption (p = .03). |
| III | Walters et al 13 (2020) | Journal of Shoulder and Elbow Surgery | 186 (70) | Reverse TSA | Postoperative active smokers (2.5) experienced less pain relief than nonsmokers (1.8) and former smokers (1.0) (P = .014). |
| III | Khazi et al 14 (2020) | Journal of Shoulder and Elbow Surgery | 12,038 (NR) | anatomic TSA & reverse TSA | Smokers at 12 months postoperatively had increased opioid dependence for anatomic TSA (OR, 1.36 [95% CI, 1.11–1.66], p = .0023), but not for reverse TSA (OR, 1.17 [95% CI, 0.96–1.41], p = .119). |
| III | Walters et al 15 (2018) | Current Orthopaedic Practice | 102 (66) | Anatomic TSA | Smokers averaged a VAS score 3.9 times higher than nonsmokers (1.3) and former smokers (1.0). Smokers to nonsmokers, p = .04. |
| III | Wells et al 16 (2018) | Journal of Shoulder and Elbow Surgery | 163 (61) | Anatomic TSA | Cumulative OME use 12 weeks postoperatively was higher in smokers (2348 mg) than nonsmokers (1637 mg) and former smokers (1623 mg) (p < .003). Average OME/day was higher in smokers than non- and former smokers (p < .003). Preoperative VAS scores were higher in smokers than non- and former smokers (p < .001) for both. Mean reduction of VAS scores was significantly lower in smokers compared to non- and former smokers (2.8 versus 4 and 4.3, p < .02). |
| IV | Martusiewicz et al 17 (2020) | Journal of Shoulder and Elbow Surgery | 50 (63) | Anatomic TSA | Smokers consumed 211.6 more MEUs than nonsmokers (SE, 92.3; P = .03), while former smokers consumed 110.9 more MEUs than nonsmokers (SE, 50.2; p = .03). |
| III | Friedman et al 18 (2019) | Journal of Shoulder and Elbow Surgery | 2421 (NR) | Anatomic TSA & reverse TSA | Smokers had increased VAS scores by 0.81 compared to nonsmokers (p < .005) for reverse TSA. Anatomic TSA findings were nonsignificant. |
CI: confidence interval; MEU: morphine equivalent units; MME: morphine milligram equivalents; NR: not reported; OME: oral morphine equivalents; OR: odds ratio; SE: standard error; TSA: total shoulder arthroplasty; VAS: visual analog scale.