关节镜膝关节手术后，术前阿片类药物的使用与持续使用、再入院和术后并发症相关。
Preoperative Opioid Use Is Associated With Persistent Use, Readmission and Postoperative Complications After Arthroscopic Knee Surgery.
机构信息
Department of Orthopaedics, Penn State Hershey Medical Center, Hershey, Pennsylvania, U.S.A..
Department of Orthopaedics, Penn State Hershey Medical Center, Hershey, Pennsylvania, U.S.A.
出版信息
Arthroscopy. 2021 May;37(5):1567-1572. doi: 10.1016/j.arthro.2020.12.187. Epub 2020 Dec 16.
PURPOSE
To evaluate factors associated with prolonged opioid use after arthroscopic knee surgery and to identify associations between preoperative usage and postoperative complications.
METHODS
The MarketScan commercial database was searched to identify patients who underwent arthroscopic knee surgery from 2005 to 2014 (based on Current Procedure Terminology code). Preoperative comorbidities including Diagnostic and Statistical Manual of Mental Disorders mental health disorders, chronic pain, chronic regional pain syndrome, obesity, tobacco use, non-narcotic medications and diabetes were queried and documented. Patients who filled opioid prescriptions 1 to 3 months before surgery were identified. Patients who filled opioid prescriptions after surgery were identified. Adjusted odds ratios and 95% confidence intervals were calculated using multivariable logistic regression analysis to determine factors associated with prolonged postoperative opioid use.
RESULTS
In total, 1,012,486 patients who underwent arthroscopic knee surgery were identified, and we determined which of these patients were on preoperative opioids. Preoperative opioid usage was associated with a statistically significant increased risk of usage out to 1 year. There was a statistically significant association between postoperative usage and preoperative variables (mental health diagnosis, smokers, chronic pain, chronic regional pain syndrome, and use of non-narcotic medications). There was a statistically significant association between preoperative opioid use and 90-day readmission and postoperative complications.
CONCLUSION
In this study, we found that patients taking opioids 1 to 3 months before arthroscopic knee surgery have increased risk of postoperative use. Additionally, chronic opioid use, chronic pain, or use of non-narcotic medications has the highest risk of postoperative opioid use. Finally, preoperative use was associated with an increased risk of 90-day readmission.
EVIDENCE
Prognostic Level IV Evidence.
目的
评估关节镜膝关节手术后延长使用阿片类药物的相关因素，并确定术前使用与术后并发症之间的关联。
方法
在 MarketScan 商业数据库中搜索 2005 年至 2014 年期间接受关节镜膝关节手术的患者（基于当前程序术语代码）。查询并记录术前合并症，包括精神障碍诊断与统计手册精神健康障碍、慢性疼痛、慢性区域性疼痛综合征、肥胖、吸烟、非麻醉性药物和糖尿病。确定在手术前 1 至 3 个月内开阿片类药物处方的患者。确定手术后开阿片类药物处方的患者。使用多变量逻辑回归分析计算调整后的优势比和 95%置信区间，以确定与延长术后阿片类药物使用相关的因素。
结果
共确定了 1012486 例接受关节镜膝关节手术的患者，并确定了这些患者中哪些人在术前使用了阿片类药物。术前使用阿片类药物与术后使用至 1 年的风险显著增加相关。术后使用与术前变量（精神健康诊断、吸烟者、慢性疼痛、慢性区域性疼痛综合征和非麻醉性药物的使用）之间存在统计学显著关联。术前使用阿片类药物与 90 天再入院和术后并发症之间存在统计学显著关联。
结论
在这项研究中，我们发现，在关节镜膝关节手术前 1 至 3 个月内服用阿片类药物的患者术后使用的风险增加。此外，慢性阿片类药物使用、慢性疼痛或非麻醉性药物的使用与术后阿片类药物使用的风险最高。最后，术前使用与 90 天再入院的风险增加有关。
证据
预后 IV 级证据。
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