Department of Orthopaedic Surgery, Brown University, Providence, Rhode Island, USA.
Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA.
Am J Sports Med. 2019 Apr;47(5):1043-1050. doi: 10.1177/0363546518819780. Epub 2019 Feb 8.
Opioid-related morbidity and mortality are major public health concerns, and the risk of long-term opioid use after shoulder arthroscopy is not well defined.
Substance abuse disorders, pain disorders, and psychiatric conditions increase the risk for prolonged opioid use.
Case-control study, Level of evidence, 3.
Insurance claims data from the Truven Health MarketScan Research Databases was used to identify patients who underwent shoulder arthroscopy between January 1, 2010, and March 31, 2015. Opioid-naïve patients were included. New prolonged opioid use was defined as continued opioid use between 91 and 180 days after the index procedure. The authors used a multivariable logistic regression model to identify patient factors associated with the risk of new prolonged opioid use.
In this cohort of 104,154 opioid-naïve adult patients, 8686 (8.3%) developed new prolonged opioid use as defined in this study. A total of 31,768 (30.5%) filled an opioid prescription in the 30 days before surgery. Patients who had limited debridement had the highest prolonged use rate (9.0%), followed by rotator cuff repair (8.5%), anterior labrum lesion repair (8.5%), and extensive debridement (8.2%). Patient characteristics associated with the highest odds ratios (ORs) of prolonged opioid use included those who had a total opioid dose during the perioperative period that was ≥743 oral morphine equivalents (ie, at least 149 tablets of 5-mg hydrocodone) (OR, 2.0; 95% CI, 1.9-2.1), followed by patients with a suicide and self-harm disorder (OR, 2.0; 95% CI, 1.1-3.4), a history of alcohol dependence or abuse (OR, 1.6; 95% CI, 1.3-1.9), a mood disorder (OR, 1.3; 95% CI, 1.2-1.4), an opioid prescription filled in the 30 days before surgery (OR, 1.3; 95% CI, 1.2-1.4), female sex (OR, 1.3; 95% CI, 1.2-1.3), an anxiety disorder (OR, 1.2; 95% CI, 1.1-1.3), and a history of a pain diagnosis (OR, 1.2; 95% CI, 1.1-1.2).
The risk of prolonged opioid use after arthroscopic shoulder procedures is 8.3%, and it is higher among women and among those with greater opioid use in the early postoperative period, mental health conditions, substance dependence and abuse, and preexisting pain disorders. Patients at high risk warrant close surveillance after surgery for early recognition and management.
阿片类药物相关发病率和死亡率是主要的公共卫生问题，肩关节镜检查后长期使用阿片类药物的风险尚不清楚。
药物滥用障碍、疼痛障碍和精神疾病会增加长期使用阿片类药物的风险。
病例对照研究，证据水平 3 级。
使用 Truven Health MarketScan Research Databases 的保险索赔数据，确定 2010 年 1 月 1 日至 2015 年 3 月 31 日期间接受肩关节镜检查的患者。纳入阿片类药物未使用的患者。新的长期阿片类药物使用定义为在指数手术后 91 至 180 天内继续使用阿片类药物。作者使用多变量逻辑回归模型确定与新的长期阿片类药物使用风险相关的患者因素。
在这项由 104154 名阿片类药物未使用的成年患者组成的队列中，8686 名（8.3%）患者出现了本研究中定义的新的长期阿片类药物使用。共有 31768 名（30.5%）患者在手术前 30 天内开了阿片类药物处方。接受有限清创术的患者长期使用率最高（9.0%），其次是肩袖修复（8.5%）、前盂唇病变修复（8.5%）和广泛清创术（8.2%）。与长期阿片类药物使用最高比值比（OR）相关的患者特征包括围手术期期间接受的总阿片类药物剂量≥743 口服吗啡当量（即至少 149 片 5mg 氢可酮）（OR，2.0；95%CI，1.9-2.1），其次是有自杀和自残障碍（OR，2.0；95%CI，1.1-3.4）、酒精依赖或滥用史（OR，1.6；95%CI，1.3-1.9）、情绪障碍（OR，1.3；95%CI，1.2-1.4）、手术前 30 天内开具的阿片类药物处方（OR，1.3；95%CI，1.2-1.4）、女性（OR，1.3；95%CI，1.2-1.3）、焦虑障碍（OR，1.2；95%CI，1.1-1.3）和疼痛诊断史（OR，1.2；95%CI，1.1-1.2）。
肩关节镜手术后长期使用阿片类药物的风险为 8.3%，女性和术后早期阿片类药物使用量较大、心理健康状况、药物依赖和滥用以及预先存在的疼痛障碍患者风险更高。高风险患者需要在手术后进行密切监测，以便及早发现和管理。
