Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY.
J Am Acad Orthop Surg Glob Res Rev. 2020 Jun 16;4(6). doi: 10.5435/JAAOSGlobal-D-20-00066. eCollection 2020 Jun.
Although chronic preoperative opioid use has been linked to inferior total joint arthroplasty outcomes, little research exists on postoperative prescribing patterns for opioid-naive orthopaedic patients versus chronic opioid users.
The New York State Prescription Monitoring Program database, which tracks controlled prescriptions dispensed in-state over the preceding 12 months, was retrospectively queried for 386 patients who underwent primary, elective total hip or knee arthroplasty at a high-volume, urban medical center from May through December 2017. Seventy-four patients were excluded because they did not return prescription monitoring program results, leaving 312 patients. Prescribers, medications, dates prescribed and filled, and quantity dispensed were recorded 3 months preoperatively through 12 months postoperatively. We defined chronic users as ≥2 opioid prescriptions filled in 3 preoperative months and opioid-naive as <2 filled. Opioid use was compared univariately using 2-tailed Student -tests.
Chronic opioid users (n = 49; 15.7%) filled an average of 13,006.64 morphine equivalent doses per patient in the 12-month postoperative period, while opioid-naive users (n = 263; 84.3%) filled an average of 854.48 morphine equivalent doses per patient ( < 0.01). Opioid use in the chronic-user group was significantly higher in each 6-week postoperative interval ( < 0.01). These trends remained significant when stratified by procedure. For opioid-naive patients, 74% of opioid prescriptions were prescribed by our orthopaedic department. For chronic users, only 21% of opioid prescriptions originated from our department. Chronic users were found to cyclically fill opioid prescriptions every 3 to 4 weeks postoperatively as far out as 12 months and were significantly more likely to fill nonopioid controlled substance prescriptions both preoperatively and postoperatively ( < 0.01).
Chronic opioid users undergoing arthroplasty filled significantly more opioid prescriptions than opioid-naive patients. Chronic users obtained prescriptions from myriad sources, only a minority of which originated from our orthopaedic department. In the current opioid epidemic, vigilance regarding opioid prescribing is critical.
尽管慢性术前阿片类药物的使用与较差的全关节置换术结果有关，但对于接受初次择期全髋关节或膝关节置换术的阿片类药物初治患者与慢性阿片类药物使用者的术后处方模式，研究甚少。
本研究回顾性分析了 2017 年 5 月至 12 月在一家大型城市医疗中心接受初次全髋关节或全膝关节置换术的 386 例患者的纽约州处方监测计划数据库，该数据库跟踪了过去 12 个月内在州内配药的受控处方。74 例患者因未返回处方监测计划结果而被排除在外，最终有 312 例患者纳入研究。记录了术前 3 个月至术后 12 个月期间的开处方者、药物、开处方和配药日期以及配药量。我们将慢性使用者定义为 3 个术前月内至少有 2 次阿片类药物处方，将阿片类药物初治者定义为<2 次。使用双尾学生 t 检验对两组患者的阿片类药物使用情况进行了单变量比较。
慢性阿片类药物使用者（n=49；15.7%）在术后 12 个月期间平均每人使用了 13006.64 吗啡等效剂量，而阿片类药物初治者（n=263；84.3%）平均每人使用了 854.48 吗啡等效剂量（<0.01）。在每个术后 6 周间隔内，慢性使用者的阿片类药物使用量均显著更高（<0.01）。这些趋势在按手术类型分层时仍然显著。对于阿片类药物初治者，74%的阿片类药物处方由我们的骨科部门开具。而对于慢性使用者，只有 21%的阿片类药物处方来自我们的部门。研究发现，慢性使用者在术后每 3 至 4 周循环性地开具阿片类药物处方，最长可达 12 个月，且他们在术前和术后均显著更有可能开具非阿片类受控物质处方（<0.01）。
接受关节置换术的慢性阿片类药物使用者开具的阿片类药物处方量明显多于阿片类药物初治患者。慢性使用者从众多来源获得处方，其中只有少数来自我们的骨科部门。在当前的阿片类药物流行中，对阿片类药物处方的警惕至关重要。
