Department of Surgery, The University of Melbourne, St Vincent's Hospital, Melbourne, Victoria, Australia.
Centre for Digital Transformation of Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia.
BMJ Open. 2020 Jun 16;10(6):e035377. doi: 10.1136/bmjopen-2019-035377.
Mounting evidence now indicates that preoperative opioid use is associated with an array of complications following total joint replacement (TJR). However, evidence of these risks remains fragmented. A comprehensive and well-integrated understanding of this body of evidence is necessary to appropriately inform treatment decisions, the allocation of limited healthcare resources, and the direction of future clinical research. The proposed systematic review and meta-analysis aims to identify and synthesise the available evidence of an association between opioid use prior to TJR and postoperative complications, categorised by complication type.
We will search MEDLINE, EMBASE, CINAHL, PsycINFO, and Web of Science from inception to April 2020. Observational and experimental studies that compare preoperative opioid users who have undergone elective TJR to opioid naïve TJR patients will be included. The primary outcomes will be postoperative complications, which will be categorised as either mortality, morbidity, or joint-related complications. The secondary outcomes will be persistent postoperative opioid use, readmission, and length of stay. Individual study quality will be assessed using the relevant NIH-NHLBI study quality assessment tools. Findings will be reported in narrative and tabular form, and, where possible, odds ratios (dichotomous outcomes) or standardised mean differences (continuous outcomes) will be reported with 95% confidence intervals. Where appropriate, random effect meta-analyses will be conducted for each outcome, and heterogeneity will be quantified using the I statistic and Cochran's Q test. This study will be reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Meta-analyses Of Observational Studies in Epidemiology (MOOSE) guidelines.
Ethics approval will not be required as no primary or private data are being collected. Findings will be disseminated through peer-reviewed publication and presentation at academic conferences.
CRD42020153047.
越来越多的证据表明，术前使用阿片类药物与全关节置换（TJR）后一系列并发症有关。然而，这些风险的证据仍然很零散。为了适当告知治疗决策、有限医疗资源的分配以及未来临床研究的方向，有必要对这方面的证据进行全面、综合的理解。本系统评价和荟萃分析旨在确定并综合术前使用阿片类药物与 TJR 后术后并发症之间的关联证据，这些并发症按并发症类型进行分类。
我们将从创建到 2020 年 4 月在 MEDLINE、EMBASE、CINAHL、PsycINFO 和 Web of Science 上进行搜索。将纳入比较术前使用阿片类药物且已接受择期 TJR 与阿片类药物未使用 TJR 患者的观察性和实验性研究。主要结果是术后并发症，将其分为死亡率、发病率或关节相关并发症。次要结果是持续性术后阿片类药物使用、再入院和住院时间。将使用相关 NIH-NHLBI 研究质量评估工具评估单个研究的质量。研究结果将以叙述性和表格形式报告，如果可能，将报告比值比（二分类结果）或标准化均数差（连续结果），并附有 95%置信区间。在适当的情况下，将对每个结果进行随机效应荟萃分析，并使用 I 统计量和 Cochran's Q 检验来量化异质性。本研究将按照系统评价和荟萃分析的首选报告项目（PRISMA）和观察性研究荟萃分析（MOOSE）指南进行报告。
由于不收集原始或私人数据，因此不需要伦理批准。研究结果将通过同行评审出版物和学术会议上的演讲进行传播。
PROSPERO 注册号：CRD42020153047。
