Pritzker School of Medicine, University of Chicago, Chicago, IL.
Department of Orthopedic Surgery and Rehabilitative Medicine, University of Chicago Medicine, Chicago, IL.
J Arthroplasty. 2019 Apr;34(4):638-644.e1. doi: 10.1016/j.arth.2018.12.023. Epub 2018 Dec 24.
Opioid prescribing after orthopedic surgeries varies widely, and there is little consensus establishing proper standards of care. This retrospective cohort study examines opioid prescribing trends following total hip (THA) and knee (TKA) arthroplasty and evaluates preoperative opioid use as a predictor of duration and magnitude of postoperative opioid use.
Patients who underwent THA or TKA in a nationwide insurance database were stratified by preoperative opioid use. Naive, sporadic, and chronic users were defined as 0, 1, or 2+ prescriptions filled 6 months before surgery. Patients were excluded for readmission or subsequent surgery. Duration of opioid use was defined as time between the procedure and the last opioid prescription record, and magnitude of opioid use was defined as quantity of pills filled by 30 days postop.
Naive patients were less likely than chronic users to fill any opioid prescription after surgery (THA: 61.5% naive vs 90.4% chronic, TKA: 72.0% naive vs 95.9% chronic), and they obtained fewer pills (THA: 73 pills naive vs 126 pills chronic, TKA: 86 pills naive vs 126 pills chronic, 5-mg oxycodone equivalent). Between 10% (THA) and 13% (TKA) of naive and between 47% (THA) and 62% (TKA) of chronic users continued opioid use at 1 year postop.
Chronic users obtain more opioids postoperatively and continue filling prescriptions for longer than naive patients. This work benchmarks norms regarding opioid use and furthermore these data highlight the powerful effect of opioid exposure during surgery as 10%-13% of naive patients continued opioids at 1 year postop.
骨科手术后阿片类药物的处方差异很大，目前对于建立适当的护理标准还没有达成共识。本回顾性队列研究调查了全髋关节置换术（THA）和全膝关节置换术（TKA）后阿片类药物的处方趋势，并评估了术前阿片类药物的使用情况作为术后阿片类药物使用持续时间和程度的预测因素。
在全国性保险数据库中接受 THA 或 TKA 的患者按术前阿片类药物使用情况分层。术前未使用、偶尔使用和慢性使用分别定义为 6 个月前手术期间未使用、使用 1 次或使用 2 次或以上的处方。排除再次入院或随后手术的患者。阿片类药物使用持续时间定义为手术与最后一次阿片类药物处方记录之间的时间，阿片类药物使用量定义为术后 30 天内使用的药丸数量。
与慢性使用者相比，术前未使用的患者术后更不可能开任何阿片类药物处方（THA：61.5%的术前未使用者 vs. 90.4%的慢性使用者，TKA：72.0%的术前未使用者 vs. 95.9%的慢性使用者），并且他们获得的药丸数量也更少（THA：73 片 vs. 126 片，TKA：86 片 vs. 126 片，5mg 羟考酮当量）。术后 1 年，10%（THA）至 13%（TKA）的术前未使用者和 47%（THA）至 62%（TKA）的慢性使用者继续使用阿片类药物。
慢性使用者术后获得更多的阿片类药物，并且比术前未使用者持续更长时间地开具处方。这项工作为阿片类药物使用制定了基准，此外，这些数据突出了手术期间阿片类药物暴露的强大影响，因为 10%-13%的术前未使用者在术后 1 年仍继续使用阿片类药物。
