Division of Orthopaedic Trauma, Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA.
Jersey City Medical Center-RWJBarnabas Health, Division of Orthopaedic Trauma & Adult Reconstruction, Department of Orthopaedic Surgery, Jersey City, NJ, USA.
Injury. 2021 Jun;52(6):1363-1369. doi: 10.1016/j.injury.2020.10.038. Epub 2020 Oct 8.
Perioperative opioid pain management protocols should reflect anticipated patient need. Fracture location and external fixation may be related to post-operative pain. The purpose of this study is to evaluate the impact of fracture location, articular injury, and pre-operative external fixation, and articular injury on perioperative opioid demand following definitive fixation.
1-month pre-operative to 1-year post-discharge opioid demand in oxycodone 5-mg equivalents in 23,441 patients undergoing fracture fixation of the femoral shaft through ankle between 2007 and 2017 was evaluated using a national database. Opioid demand was compiled over several timeframes: 1-month pre-op to 90-days post-discharge, 3 months post-discharge to 1-year post-discharge, and 1-month pre-op to 1-year post-discharge. Multivariable main effects linear and logistic regression models were constructed to evaluate the increased opioids filled, increased opioid prescriptions, and odds of refills in these timeframes with adjustment for fracture location, external fixator placement, and baseline patient and injury characteristics.
Lower extremity anatomic location and pre-operative external fixation were significantly associated with increased 1-month pre-op to 1-year post-discharge opioid filling (17.6-54.7 additional oxycodone 5-mg equivalents, all p<0.05) and number of filled prescriptions (0.28-0.54 additional prescriptions, all p<0.05). Pilon fractures and pre-operative external fixation, specifically, were associated with increased odds of two or more opioid prescriptions within the 1-month pre-op to 1-year post-discharge time frame (1.25-1.32 odds ratio, all p<0.05).
Fracture location and pre-operative external fixator placement predicted perioperative opioid demand. Articular zone (pilon, plateau, and distal femur) fracture fixation was associated with the largest increases in opioid demand after lower extremity fracture fixation. Patients with these injuries may be at highest risk of extensive opioid consumption.
围手术期阿片类药物疼痛管理方案应反映预期的患者需求。骨折部位和外固定器的位置可能与术后疼痛有关。本研究的目的是评估骨折部位、关节损伤以及术前外固定器和关节损伤对确定性固定后围手术期阿片类药物需求的影响。
使用全国性数据库评估了 2007 年至 2017 年间 23441 例股骨干骨折通过踝关节行内固定术的患者，术前 1 个月至出院后 1 年的阿片类药物需求，以羟考酮 5mg 等效物计算。将阿片类药物需求汇总到以下几个时间段：术前 1 个月至出院后 90 天、出院后 3 个月至出院后 1 年、术前 1 个月至出院后 1 年。使用多变量主效应线性和逻辑回归模型，在调整骨折部位、外固定器放置和基线患者及损伤特征后，评估这些时间段内阿片类药物的增加用量、增加的阿片类药物处方和续药的可能性。
下肢解剖部位和术前外固定器与术前 1 个月至术后 1 年的阿片类药物填充量增加（17.6-54.7 额外羟考酮 5mg 等效物，均 P<0.05）和填充处方数量增加（0.28-0.54 额外处方，均 P<0.05）显著相关。特别是 pilon 骨折和术前外固定器与术前 1 个月至术后 1 年期间需要两份或更多阿片类药物处方的可能性增加相关（1.25-1.32 比值比，均 P<0.05）。
骨折部位和术前外固定器的位置预测围手术期阿片类药物需求。关节区（pilon、平台和股骨远端）骨折固定与下肢骨折固定后阿片类药物需求的增加幅度最大。这些损伤的患者可能面临最高的阿片类药物消耗风险。
