Orthopedics. 2021 Jan 1;44(1):e101-e106. doi: 10.3928/01477447-20200928-02. Epub 2020 Oct 1.
Evidence is limited regarding cannabinoid use among total joint arthroplasty (TJA) patients, despite increased availability and popularity for treating chronic pain. The authors hypothesized that preoperative cannabinoid use increased and opioid use decreased during a 6-year interval in total hip arthroplasty (THA) and total knee arthroplasty (TKA) patients, and also asked whether complications were associated with use of these substances. This retrospective, single-institution study reviewed electronic medical records and the Veterans Affairs Surgical Quality Improvement Program (VASQIP) database for TJA cases from 2012 through 2017. Primary outcomes were the prevalence and trends of active cannabinoid and opioid use, as determined by routine preoperative urine toxicology screening. Multivariable regression analyses were conducted to investigate a secondary outcome, whether there was an association between cannabinoid or opioid use and postoperative complications. A total of 1778 operations (1161 TKAs and 617 THAs) performed on 1519 patients were reviewed. The overall prevalence of pre-operative cannabinoid and opioid use was 11% and 23%, respectively. Comparing 2012 with 2017, cannabinoid use increased from 9% to 15% (P=.049), and opioid use decreased from 24% to 17% (P=.040). Cannabinoid users were more likely to be taking opioids than nonusers (P=.002). Controlling for age, sex, surgery type, and American Society of Anesthesiologists score, cannabinoid use was not associated with 90-day readmission, infection, reoperation, or other VASQIP-captured complications. Laboratory testing indicated a much higher prevalence of cannabinoid use among TJA patients than previously reported. During a 6-year period, cannabinoid use increased more than 60%, and opioid use decreased approximately 30%. These findings indicate that cannabinoid use did not appear to be associated with perioperative complications. [Orthopedics. 2021;44(1):e101-e106.].
证据表明，尽管大麻素类药物在治疗慢性疼痛方面的可及性和普及度有所增加，但在接受全髋关节置换术（THA）和全膝关节置换术（TKA）的患者中，其使用情况仍有限。作者假设在 6 年的时间间隔内，THA 和 TKA 患者的术前大麻素类药物使用增加，阿片类药物使用减少，并询问这些物质的使用是否与并发症有关。这项回顾性、单机构研究对 2012 年至 2017 年期间的 TJA 病例进行了电子病历和退伍军人事务部手术质量改进计划（VASQIP）数据库的审查。主要结果是通过常规术前尿液毒物筛查确定的活性大麻素和阿片类药物使用的流行率和趋势。进行多变量回归分析以研究次要结果，即大麻素或阿片类药物使用与术后并发症之间是否存在关联。共回顾了 1519 名患者的 1778 例手术（1161 例 TKA 和 617 例 THA）。术前大麻素和阿片类药物使用的总体流行率分别为 11%和 23%。与 2012 年相比，2017 年大麻素的使用从 9%增加到 15%（P=.049），阿片类药物的使用从 24%减少到 17%（P=.040）。与非使用者相比，使用者更有可能同时服用阿片类药物（P=.002）。控制年龄、性别、手术类型和美国麻醉医师协会评分后，大麻素的使用与 90 天内再入院、感染、再次手术或其他 VASQIP 捕获的并发症无关。实验室检测表明，接受 TJA 的患者中大麻素的使用比以前报告的要高得多。在 6 年期间，大麻素的使用增加了 60%以上，而阿片类药物的使用减少了约 30%。这些发现表明，大麻素的使用似乎与围手术期并发症无关。[骨科。2021；44(1):e101-e106.]。
