Department of Orthopaedic Surgery, Long Island Jewish Medical Center, Northwell Health, New York, NY.
Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH.
J Arthroplasty. 2020 Jun;35(6S):S237-S240. doi: 10.1016/j.arth.2020.02.014. Epub 2020 Feb 13.
The purpose of this study was to investigate whether opioid use disorder (OUD) patients are at greater odds than non-opioid use disorder (NUD) patients in developing (1) thromboembolic complications; (2) readmission rates; and (3) costs of care.
All patients with a 90-day history of OUD before total hip arthroplasty (THA) were identified from a national database. Patients were matched 1:5 to controls by age, gender, Elixhauser Comorbidity Index scores, and high-risk medical comorbidities, yielding 38,821 patients with (n = 6398) and without (n = 31,883) OUD. Multivariate logistic regression analyses were performed to compare the risks of developing venous thromboembolism (deep vein thrombosis and/or pulmonary embolism) 90 days after the index procedure, 90-day readmission rates, and total global 90-day episode of care costs.
Patients with a history of OUD were found to be at greater risk for 90-day venous thromboembolisms (2.38 vs. 1.07%; OR: 2.25, 95% CI: 1.86-2.73, P < .0001) compared with matched NUD patients. Specifically, OUD patients were at greater risk for both deep vein thromboses (2.13 vs. 0.87%; OR: 2.46, 95% CI: 2.00-3.03, P < .001) and pulmonary embolism (0.61 vs. 0.27%; OR: 2.24, 95% CI: 1.53-3.27, P < .0001). In addition, patients with OUD were at an increased risk for 90-day readmission (28.68 vs. 22.62%; OR: 1.37, 95% CI: 1.29-1.46, P < .0001) compared with controls. Primary THA patients with OUD incurred a 14.72% higher cost of care ($20,610.65 vs. $17,964.58) compared with NUD patients.
These findings demonstrate that primary THA patients with a history of OUD are at greater risks for thromboembolic complications, readmissions, and higher costs of care in the 90-day postoperative period.
本研究旨在探讨阿片类药物使用障碍（OUD）患者是否比非阿片类药物使用障碍（NUD）患者更有可能出现以下情况：（1）血栓栓塞并发症；（2）再入院率；以及（3）治疗费用。
从全国数据库中确定了所有在全髋关节置换术（THA）前 90 天有 OUD 病史的患者。通过年龄、性别、Elixhauser 合并症指数评分和高危医疗合并症，将患者与对照组进行 1:5 配对，共得到 38821 例患者（n=6398）和无 OUD 史的患者（n=31883）。采用多变量逻辑回归分析比较两组患者在索引手术后 90 天内发生静脉血栓栓塞（深静脉血栓形成和/或肺栓塞）、90 天内再入院率以及 90 天内总全球治疗费用的风险。
与匹配的 NUD 患者相比，有 OUD 病史的患者 90 天内静脉血栓栓塞的风险更高（2.38% vs. 1.07%；OR：2.25，95%CI：1.86-2.73，P<.0001）。具体来说，OUD 患者深静脉血栓形成（2.13% vs. 0.87%；OR：2.46，95%CI：2.00-3.03，P<.001）和肺栓塞（0.61% vs. 0.27%；OR：2.24，95%CI：1.53-3.27，P<.0001）的风险均更高。此外，OUD 患者 90 天内再入院的风险也增加（28.68% vs. 22.62%；OR：1.37，95%CI：1.29-1.46，P<.0001）。与 NUD 患者相比，OUD 合并原发性 THA 的患者的治疗费用高出 14.72%（20610.65 美元 vs. 17964.58 美元）。
这些发现表明，有 OUD 病史的原发性 THA 患者在术后 90 天内发生血栓栓塞并发症、再入院和治疗费用增加的风险更高。
