Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, NY, USA; Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA.
Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, NY, USA.
Br J Anaesth. 2021 Jun;126(6):1217-1225. doi: 10.1016/j.bja.2020.12.046. Epub 2021 Mar 3.
Scarce data exist on differential opioid prescribing between men and women in the pre-, peri-, and postoperative phases of care among patients undergoing total hip/knee arthroplasty (THA/TKA).
In this retrospective population-based study, Truven Health MarketScan claims data were used to establish differences between men and women in (1) opioid prescribing in the year before THA/TKA surgery, (2) the amount of opioids prescribed at discharge, and (3) chronic opioid prescribing (3-12 months after surgery). Multivariable regression models measured odds ratios (OR) with 95% confidence intervals (95% CI).
Among 29 038 THAs (42% men) and 48 523 TKAs (52% men) men (compared with women) were less likely to receive an opioid prescription in the year before surgery (54% vs 60%, and 54% vs 60% for THA and TKA, respectively); P<0.001. However, in multivariable analyses male sex was associated with higher total opioid dosages prescribed at discharge after THA (OR=1.04; 95% CI 1.03, 1.06) and TKA (OR=1.05; 95% CI 1.04, 1.06); both P<0.001. Chronic opioid prescribing was found in 10% of the cohort (THA: n=2333; TKA: n=5365). Here, men demonstrated lower odds of persistent opioid prescribing specifically after THA (OR=0.90; 95% CI 0.82, 0.99) but not TKA (OR=0.96; 95% CI 0.90, 1.02); P=0.026 and P=0.207, respectively.
We found sex-based differences in opioid prescribing across all phases of care for THA/TKA. The results highlight temporal opportunities for targeted interventions to improve outcomes after total joint arthroplasty, particularly for women, and to decrease chronic opioid prescribing.
在接受全髋关节/膝关节置换术（THA/TKA）的患者的术前、围术期和术后阶段，有关男性和女性之间阿片类药物处方差异的相关数据十分有限。
在这项回顾性基于人群的研究中，我们使用 Truven Health MarketScan 索赔数据来确定男性和女性之间的差异：（1）THA/TKA 手术前一年的阿片类药物处方；（2）出院时开的阿片类药物的剂量；（3）术后 3-12 个月的慢性阿片类药物处方。多变量回归模型使用比值比（OR）和 95%置信区间（95%CI）进行测量。
在 29038 例 THA（42%为男性）和 48523 例 TKA（52%为男性）中，与女性相比，男性在术前一年（THA：54%对 60%；TKA：54%对 60%）更不可能接受阿片类药物处方（P<0.001）。然而，在多变量分析中，男性与 THA（OR=1.04；95%CI 1.03，1.06）和 TKA（OR=1.05；95%CI 1.04，1.06）出院时开具的总阿片类药物剂量较高相关（均 P<0.001）。在队列中发现慢性阿片类药物处方的比例为 10%（THA：n=2333；TKA：n=5365）。在这里，男性在接受 THA 后持续开具阿片类药物的可能性较低（OR=0.90；95%CI 0.82，0.99），但在接受 TKA 后则无此情况（OR=0.96；95%CI 0.90，1.02）（P=0.026 和 P=0.207）。
我们发现 THA/TKA 治疗的所有阶段中，阿片类药物处方存在基于性别的差异。这些结果强调了在全关节置换术后改善结果，特别是对女性，以及减少慢性阿片类药物处方的有针对性干预的时机。
