Department of Orthopedic Surgery, University of Miami Hospital, Miami, Florida.
Maimonides Medical Center, Department of Orthopaedic Surgery, Brooklyn, New York.
Foot Ankle Spec. 2022 Aug;15(4):305-311. doi: 10.1177/1938640020950105. Epub 2020 Aug 28.
Patients with a history of opioid use disorder (OUD) tend to have more complications, higher readmission rates, and increased costs following orthopaedic procedures. This study evaluated patients undergoing hallux valgus correction for their odds of increased (1) readmission rates, (2) emergency room (ER) visits, and (3) costs.
Patients undergoing hallux valgus corrections with OUD history were identified using a national Medicare administrative claims database of approximately 24 million orthopaedic surgery patients. OUD patients were matched to non-opioid use disorder (NUD) patients in a 1:4 ratio by age, sex, Elixhauser-Comorbidity Index (ECI), diabetes mellitus, hyperlipidemia, hypertension, and tobacco use. The query yielded 6318 patients (OUD = 1276; NUD = 5042) who underwent a hallux valgus correction. Primary outcomes analyzed included odds of 90-day readmission rates, 30-day ER visits, and 90-day episode-of-care costs. Demographics, odds ratios (ORs), ECI, and cost were assessed as appropriate using a Pearson χ test, logistic regression, and a test. A value <.05 was considered statistically significant.
There were no significant differences in demographics between OUD and NUD patients. OUD patients had higher incidence and odds of 90-day readmission (9.56% vs 6.04%; OR = 1.55; < .001) and 30-day ER visits (0.86% vs 0.35%; OR = 2.42; = .021) and incurred greater 90-day episode-of-care costs ($7208.28 vs $6134.75; < .001) compared with NUD patient controls.
The study demonstrates the possible influence of OUD on higher odds of readmission, ER visits, and costs following a hallux valgus correction.
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有阿片类药物使用障碍（OUD）病史的患者在接受骨科手术后往往会出现更多并发症、更高的再入院率和更高的费用。本研究评估了接受拇外翻矫正手术的患者增加（1）再入院率、（2）急诊室（ER）就诊和（3）费用的几率。
使用全国医疗保险行政索赔数据库中约 2400 万例骨科手术患者，确定有 OUD 病史的患者接受拇外翻矫正术。通过年龄、性别、Elixhauser 合并症指数（ECI）、糖尿病、高血脂、高血压和吸烟史，将 OUD 患者与无阿片类药物使用障碍（NUD）患者以 1:4 的比例进行匹配。查询共产生 6318 例患者（OUD=1276；NUD=5042）接受了拇外翻矫正术。分析的主要结果包括 90 天再入院率、30 天 ER 就诊和 90 天治疗费用的几率。使用 Pearson χ 检验、逻辑回归和 t 检验评估人口统计学、优势比（ORs）、ECI 和费用，适当使用。P 值<.05 被认为具有统计学意义。
OUD 和 NUD 患者在人口统计学方面没有显著差异。OUD 患者的 90 天再入院率（9.56%对 6.04%；OR=1.55；<.001）和 30 天 ER 就诊率（0.86%对 0.35%；OR=2.42；<.021）和 90 天治疗费用（$7208.28 对 $6134.75；<.001）均高于 NUD 患者对照组。
本研究表明，OUD 可能会增加拇外翻矫正术后再入院、ER 就诊和费用的几率。
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