Orthopedic Research Institute, Holy Cross Hospital, Fort Lauderdale, FL.
Department of Orthopedic Surgery, Massachusetts General Hospital, Boston, MA.
J Arthroplasty. 2020 Jan;35(1):178-181. doi: 10.1016/j.arth.2019.08.003. Epub 2019 Aug 7.
Opioid use disorders (OUD) are a major cause of morbidity and mortality. The authors of this study hypothesize that patients who have an OUD will have greater relative risk of implant-related complications, periprosthetic joint infections (PJIs), readmission rates, and will incur greater costs compared to non-opioid use disorder (NUD) patients following primary total hip arthroplasty (THA).
OUD patients who underwent a THA between 2005 and 2014 were identified and matched to controls in a 1:5 ratio according to age, sex, a comorbidity index, and various medical comorbidities yielding 42,097 patients equally distributed in both cohorts. Pearson's chi-square analyses were used to compare patient demographics. Relative risk (RR) was used to analyze and compare risk of 2-year implant-related complications, 90-day PJIs, and 90-day readmission rates. Welch's t-tests were used to compare day of surgery and 90-day episode-of-care costs between the cohorts. A P value less than .006 was considered statistically significant.
OUD patients had higher incidences and risks of implant-related complications (11.99% vs 6.68%; RR, 1.74; P < .001), developing PJIs within 90 days (2.38% vs 1.81%; RR, 1.32; P = .001), and 90-day readmissions (21.49% vs 17.35%; RR, 1.23; P < .001). Additionally, the study demonstrated OUD patients incurred greater day of surgery ($14,384.30 vs $13,150.12, P < .0001) and 90-day costs ($21,183.82 vs $18,709.02, P < .0001) compared to controls.
After controlling for age, sex, a comorbidity index, and various medical complications, OUD patients are at greater risk to experience implant-related complications, PJIs, readmissions, and have greater costs following primary THA compared to non-OUD patients. This study should help orthopedic surgeons counsel their patients of potential complications which may arise following their primary THA.
阿片类药物使用障碍（OUD）是发病率和死亡率的主要原因。本研究的作者假设，与非阿片类药物使用障碍（NUD）患者相比，接受初次全髋关节置换术（THA）的 OUD 患者发生与植入物相关的并发症、假体周围关节感染（PJI）、再入院率的相对风险更高，并且会产生更高的成本。
在 2005 年至 2014 年期间，确定了接受 THA 的 OUD 患者，并根据年龄、性别、合并症指数和各种医疗合并症以 1:5 的比例与对照组进行匹配，产生了 42097 名患者，两组之间平均分配。使用 Pearson 卡方分析比较患者人口统计学特征。使用相对风险（RR）分析和比较 2 年植入物相关并发症、90 天 PJI 和 90 天再入院率的风险。使用 Welch t 检验比较两组之间手术当天和 90 天疗程的费用。P 值小于.006 被认为具有统计学意义。
OUD 患者发生与植入物相关的并发症（11.99%比 6.68%；RR，1.74；P<.001）、90 天内发生 PJI（2.38%比 1.81%；RR，1.32；P=.001）和 90 天再入院的风险更高（21.49%比 17.35%；RR，1.23；P<.001）。此外，该研究表明 OUD 患者的手术当天费用（$14384.30 比 $13150.12，P<.0001）和 90 天费用（$21183.82 比 $18709.02，P<.0001）均高于对照组。
在控制年龄、性别、合并症指数和各种医疗并发症后，与非 OUD 患者相比，OUD 患者在初次 THA 后发生与植入物相关的并发症、PJI、再入院的风险更高，并且费用更高。本研究应有助于骨科医生为他们的患者提供有关初次 THA 后可能出现的潜在并发症的咨询。
