SWS Clinical School, UNSW, Locked Bag 7103, Liverpool BC, Liverpool, NSW, 1871, Australia.
South West Sydney Local Health District, Locked Bag 7103, Liverpool BC, Liverpool, NSW, 1871, Australia.
BMC Musculoskelet Disord. 2020 Jun 22;21(1):398. doi: 10.1186/s12891-020-03413-z.
Retrospective studies have found that daily opioid use pre-arthroplasty predicts worse longer-term service, clinical and patient-reported outcomes. Prospective studies are needed to confirm these observations. This prospective, exploratory study aimed to determine: the proportion of total knee or hip arthroplasty (TKA, THA) patients who use opioids regularly (daily) pre-surgery; if opioid use pre-surgery is associated with acute and sub-acute outcomes to 12-weeks post-surgery.
Consecutive patients undergoing primary TKA or THA were prospectively enrolled pre-surgery and followed-up by telephone to 12-weeks post-surgery. Acute-care (oral morphine equivalent dosage (OMED), length of stay, discharge to inpatient rehabilitation, complications) and 12-week outcomes (Oxford Knee or Hip Score, Euroqol 'today' health score, current use of opioids, and complications including readmissions) were monitored. Unadjusted and adjusted Odds Ratios (ORs) (95% Confidence Interval, CI), Rate Ratios and β coefficients (standard error) were calculated.
Five Hundred Twenty-One patients were included (TKA n = 381). 15.7% (95%CI 12.6 to 18.9) used opioids regularly pre-surgery. 86.8% (452/521) were available for follow-up at 12-weeks. In unadjusted analyses, pre-surgical opioid use was significantly associated with higher average acute daily OMED [β 0.40 (0.07), p < 0.001], presence of an acute complication [OR 1.75 (1.02 to 3.00)], and ongoing use of opioids at 12-weeks [OR 5.06 (2.86 to 8.93)]. After adjusting for covariates, opioid use pre-surgery remained significantly associated with average acute daily OMED [β 0.40 (0.07), p < 0.001] and ongoing use at 12-weeks [OR 5.38 (2.89 to 9.99)].
People who take daily opioids pre-surgery have significantly greater odds for greater opioid consumption acutely and ongoing use post-surgery. Adequately powered prospective studies are required to confirm whether pre-surgical opioid use is or is not associated with poorer joint and quality of life scores or a complication in the short-term.
回顾性研究发现，术前每日使用阿片类药物与长期预后不佳、临床和患者报告的结果更差相关。需要前瞻性研究来证实这些观察结果。本前瞻性探索性研究旨在确定：接受全膝关节或髋关节置换术（TKA、THA）的患者中有多少人术前经常（每日）使用阿片类药物；术前使用阿片类药物是否与术后 12 周的急性和亚急性结果相关。
连续纳入术前接受初次 TKA 或 THA 的患者，并在术后通过电话随访至 12 周。监测急性护理（口服吗啡等效剂量（OMED）、住院时间、住院康复后出院、并发症）和 12 周结局（牛津膝关节或髋关节评分、欧洲五维健康量表 '今天' 评分、当前使用阿片类药物、包括再入院在内的并发症）。计算未经调整和调整后的优势比（OR）（95%置信区间，CI）、率比和β系数（标准误差）。
共纳入 521 例患者（TKA n=381）。术前 15.7%（95%CI 12.6 至 18.9）的患者经常使用阿片类药物。521 例患者中，有 86.8%（452/521）在 12 周时可进行随访。在未经调整的分析中，术前使用阿片类药物与较高的平均急性每日 OMED 显著相关 [β 0.40（0.07），p<0.001]，存在急性并发症 [OR 1.75（1.02 至 3.00）]，以及在 12 周时持续使用阿片类药物 [OR 5.06（2.86 至 8.93）]。在调整协变量后，术前使用阿片类药物仍与平均急性每日 OMED 显著相关 [β 0.40（0.07），p<0.001] 和 12 周时持续使用 [OR 5.38（2.89 至 9.99）]。
术前每日使用阿片类药物的患者在术后急性和持续使用阿片类药物方面有更高的几率。需要进行充分的前瞻性研究来证实术前使用阿片类药物是否与短期关节和生活质量评分更差或并发症相关。
