Lipof Jason S, Thirukumaran Caroline P, Greenstein Alexander S, Zmich Zachary, Lander Alexander, Ricciardi Benjamin F
Orthopedics. 2019 Nov 1;42(6):361-367. doi: 10.3928/01477447-20190723-06. Epub 2019 Jul 29.
Abuse of opiate medications has reached epidemic proportions, and elective total hip arthroplasty (THA) and total knee arthroplasty (TKA) typically require outpatient use of narcotic medications. This survey sought to determine opiate-prescribing habits of members of the American Association of Hip and Knee Surgeons (AAHKS) for patients undergoing primary THA and TKA. An 11-question online survey was developed to evaluate current prescribing habits for opiate and nonopiate medications prescribed after primary THA and TKA. An invitation to complete the survey was e-mailed to 2698 orthopedic surgeons using an AAHKS listserv. Surgeons' demographic information and their prescribing habits of opiate and nonopiate medications postdischarge were recorded. Data were examined using descriptive statistics, chi-square, and multivariate logistic regression. Responses were received from 325 of 2698 (12.1%) AAHKS members. Significant variation in the type of opiate prescribed and the number of pills dispensed was observed. Higher surgical volume and less years in surgical practice were associated with a higher number of opiate pills prescribed after THA and TKA. There were no statistically significant associations between opiates prescribed and use of an ambulatory surgery center or presence of departmental guidelines. Although THA and TKA are relatively standardized procedures performed nationwide, significant variability exists among surgeons regarding postdischarge opiate- and nonopiate-prescribing habits. There is a need for greater standardization to create a unified, evidence-based, and safe regimen for the postoperative period while reducing the opiate burden in the surrounding community. [Orthopedics. 2019; 42(6):361-367.].
阿片类药物的滥用已达到流行程度，而选择性全髋关节置换术（THA）和全膝关节置换术（TKA）通常需要患者在门诊使用麻醉药物。这项调查旨在确定美国髋膝关节外科医生协会（AAHKS）成员针对接受初次THA和TKA手术患者的阿片类药物处方习惯。开展了一项包含11个问题的在线调查，以评估初次THA和TKA术后开具阿片类和非阿片类药物的当前处方习惯。通过AAHKS邮件列表向2698名骨科医生发送了完成该调查的邀请。记录了外科医生的人口统计学信息以及他们出院后开具阿片类和非阿片类药物的处方习惯。使用描述性统计、卡方检验和多变量逻辑回归对数据进行了分析。共收到2698名AAHKS成员中325名（12.1%）的回复。观察到所开阿片类药物类型和发放药丸数量存在显著差异。手术量较高以及外科从业年限较短与THA和TKA术后开具的阿片类药丸数量较多有关。所开阿片类药物与使用门诊手术中心或存在科室指南之间无统计学显著关联。尽管THA和TKA在全国范围内是相对标准化的手术，但外科医生在出院后阿片类和非阿片类药物处方习惯方面存在显著差异。需要进行更大程度的标准化，以制定一个统一、基于证据且安全的术后治疗方案，同时减轻周边社区的阿片类药物负担。[《骨科学》。2019年；42(6):361 - 367。]
