Meredith Sean J, Nadarajah Vidushan, Jauregui Julio J, Smuda Michael P, Medina Shaun H, Bennett Craig H, Packer Jonathan D, Henn R Frank
Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland.
Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Medical Center, Brooklyn, New York.
J Knee Surg. 2019 Jul;32(7):630-636. doi: 10.1055/s-0038-1666868. Epub 2018 Jul 10.
A cross-sectional analysis of data derived from patients undergoing knee surgery at a single institution was conducted. The objectives of the study were to determine the demographic, diagnostic, and psychologic factors associated with opioid use; and to determine the clinical correlates of opioid use. We hypothesized that preoperative opioid use would be associated with worse patient-reported outcome (PRO) measures. The sample consisted of 383 patients undergoing knee surgery. The patients were classified as either opioid or nonopioid users on the basis of medical record review. All participants completed a battery of clinical assessments, including the Patient-Reported Outcomes Measurement Information System computer adaptive testing in six domains: Physical Function, Pain Interference, Fatigue, Social Satisfaction, Anxiety, and Depression. Analyses were conducted to examine clinical variables as a function of opioid use. The results indicated that opioid use was associated with female gender, unemployment, smoking, higher American Society of Anesthesiologists scores, greater number of previous surgeries, depression or anxiety, and worse expectation of surgery ( < 0.05). Multivariable analysis found opioid use to be a significant independent predictor of multiple PRO measures in patients undergoing knee surgery. Potential explanations for these findings are presented, and clinical implications are discussed.
对来自一家机构接受膝关节手术患者的数据进行了横断面分析。该研究的目的是确定与阿片类药物使用相关的人口统计学、诊断和心理因素；并确定阿片类药物使用的临床相关性。我们假设术前使用阿片类药物会与患者报告结局（PRO）指标较差相关。样本包括383例接受膝关节手术的患者。根据病历审查将患者分为阿片类药物使用者或非阿片类药物使用者。所有参与者完成了一系列临床评估，包括患者报告结局测量信息系统在六个领域的计算机自适应测试：身体功能、疼痛干扰、疲劳、社会满意度、焦虑和抑郁。进行分析以检查作为阿片类药物使用函数的临床变量。结果表明，阿片类药物使用与女性、失业、吸烟、美国麻醉医师协会评分较高、既往手术次数较多、抑郁或焦虑以及对手术的较差预期相关（P<0.05）。多变量分析发现，阿片类药物使用是膝关节手术患者多项PRO指标的显著独立预测因素。提出了这些发现的潜在解释，并讨论了临床意义。
