Centre for Musculoskeletal Outcomes Research, Department of Surgical Sciences, University of Otago, Dunedin, New Zealand.
Department of Surgery, St Vincent's Hospital, University of Melbourne, Melbourne, Victoria, Australia.
J Arthroplasty. 2020 Nov;35(11):3099-3107.e14. doi: 10.1016/j.arth.2020.06.040. Epub 2020 Jun 27.
Patients awaiting total joint arthroplasty (TJA) have high rates of opioid use, and many continue to use opioid medications long term after surgery. The objective of this study is to estimate the risk factors associated with chronic opioid use after TJA in a comprehensive population-based cohort.
All patients undergoing TJA in the New Zealand public healthcare system were identified from Ministry of Health records. Dispensing of opioid medications up to 3 years postsurgery and potential risk factors, including demographic, socioeconomic, and surgery-related characteristics, pre-existing medical comorbidities, and use of other analgesic medications prior to surgery, were identified from linked population databases. Logistic regression analysis was used to identify factors associated with chronic postoperative opioid use.
The strongest risk factor for chronic postoperative opioid use was preoperative opioid use. Other significant risk factors included perioperative opioid use, history of alcohol or drug abuse, younger age, female gender, knee arthroplasty, several comorbid health conditions, and preoperative use of some analgesic medications. Protective factors included higher education levels and preoperative use of nonsteroidal anti-inflammatory drugs. Most risk factors had similar effects on chronic postoperative opioid use irrespective of the length of follow-up considered (1, 2, or 3 years).
This study of a comprehensive nationwide population-based cohort of TJA patients with 3 years of follow-up identified several modifiable risk factors and other easily measured patient characteristics associated with higher risk of long-term postoperative opioid use.
接受全关节置换术 (TJA) 的患者有很高的阿片类药物使用率，许多患者在手术后仍长期使用阿片类药物。本研究的目的是在一个全面的基于人群的队列中估计与 TJA 后慢性阿片类药物使用相关的风险因素。
从卫生部的记录中确定了新西兰公共医疗体系中接受 TJA 的所有患者。从相关人群数据库中确定了手术后 3 年内的阿片类药物配药情况以及潜在的风险因素，包括人口统计学、社会经济和手术相关特征、术前并存的医疗合并症以及手术前使用其他镇痛药物。使用逻辑回归分析来确定与慢性术后阿片类药物使用相关的因素。
慢性术后阿片类药物使用的最强风险因素是术前阿片类药物使用。其他显著的风险因素包括围手术期阿片类药物使用、酒精或药物滥用史、年龄较小、女性、膝关节置换术、几种并存的健康状况以及术前使用某些镇痛药物。保护因素包括较高的教育水平和术前使用非甾体抗炎药。大多数风险因素对慢性术后阿片类药物使用的影响相似，无论考虑的随访时间（1、2 或 3 年）如何。
本研究对接受 TJA 的全面全国性基于人群队列进行了为期 3 年的随访，确定了一些可改变的风险因素和其他易于测量的患者特征，这些特征与长期术后阿片类药物使用的风险增加相关。
