Inacio Maria C S, Pratt Nicole L, Roughead Elizabeth E, Paxton Elizabeth W, Graves Stephen E
Medicine and Device Surveillance Centre of Research Excellence, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, GPO Box 2471, Adelaide, 5001, South Australia, Australia.
Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, GPO Box 2471, Adelaide, 5001, South Australia, Australia.
BMC Musculoskelet Disord. 2016 Mar 10;17:122. doi: 10.1186/s12891-016-0970-6.
Pain is an indication for total hip arthroplasty (THA) and it should be resolved post-surgery. Because patients' pain is typically treated pharmacologically we tested whether opioid use can be used as a surrogate for patient-reported pain and as an indicator for early surgical failure. Specifically, we evaluated whether the amount of opioids taken within the year after THA was associated with one and five years risk of revision surgery.
A cohort of 9943 THAs (01/2001-12/2012) was evaluated. Post-operative opioid use was the exposure of interest and cumulative daily oral morphine equivalent (OME) amounts were calculated. Total OMEs/90-day periods were categorised into quartiles. Revisions within one and five years were the outcomes of interest.
Of the THAs, 2.0 % (N = 200) were revised within one year and 4.2 % (N = 413) within five years. After adjustments for gender, age, surgical indication, co-morbidities, and other analgesics, revision was associated with amount of OMEs in the second quarter after THA (days 91-180 after discharge). Patients on medium-high amounts of OME (400-1119 mg) had higher risk of one (hazard ratio (HR) = 2.22, 95 % CI 1.08-4.56) and five year (HR = 1.66, 95 % CI 1.08-2.56) revision than a patient not taking opioids. During the same period, patients taking the highest amounts of OMEs (≥1120 mg) had a 2.64 (95 % CI 1.03-6.74) times higher risk of one year and a 2.11 (95 % CI 1.13-3.96) times higher risk of five year revision.
Opioid use 91-180 days post-surgery is associated with higher risk of revision surgery and therefore is an early and useful indicator for surgical failure.
疼痛是全髋关节置换术（THA）的一个指征，术后疼痛应得到缓解。由于患者的疼痛通常采用药物治疗，我们测试了阿片类药物的使用是否可作为患者报告疼痛的替代指标以及早期手术失败的指标。具体而言，我们评估了THA术后一年内服用阿片类药物的量是否与翻修手术1年和5年的风险相关。
对9943例THA手术患者（2001年1月至2012年12月）进行队列研究。术后阿片类药物的使用情况是研究的暴露因素，并计算每日口服吗啡当量（OME）的累积量。将每90天的总OME量分为四分位数。1年和5年内的翻修手术是研究的结局指标。
在这些THA手术患者中，2.0%（N = 200）在1年内进行了翻修，4.2%（N = 413）在5年内进行了翻修。在对性别、年龄、手术指征、合并症和其他镇痛药进行调整后，翻修手术与THA术后第二季度（出院后91 - 180天）的OME量相关。服用中高剂量OME（400 - 1119毫克）的患者1年（风险比（HR）= 2.22，95%可信区间1.08 - 4.56）和5年（HR = 1.66，95%可信区间1.08 - 2.56）翻修的风险高于未服用阿片类药物的患者。在同一时期，服用最高剂量OME（≥1120毫克）的患者1年翻修风险高2.64倍（95%可信区间1.03 - 6.74），5年翻修风险高2.11倍（95%可信区间1.13 - 3.96）。
术后91 - 180天使用阿片类药物与翻修手术风险较高相关，因此是手术失败的一个早期且有用的指标。
