Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
J Shoulder Elbow Surg. 2021 Jul;30(7S):S153-S158. doi: 10.1016/j.jse.2021.04.005. Epub 2021 Apr 21.
Prescription opioid misuse has become an epidemic in the United States and is a leading cause of death in Americans. Postoperative opioid prescriptions are a significant contributor to the opioid epidemic, with orthopedic surgeons being the third highest prescribers of opioid prescriptions among physicians across all specialties. Our aim was to retrospectively evaluate overall opioid consumption patterns following surgical treatment for shoulder pathology and recommend evidence-based guidelines for standardized postoperative opioid prescriptions.
We conducted a retrospective chart review of patients who underwent shoulder arthroscopy or arthroplasty from a single shoulder/elbow fellowship-trained surgeon (principal investigator). Patient and surgery characteristics were summarized for the entire sample and further stratified by surgery type. Total opioid consumption at the time of the first postoperative visit and refill patterns were compared between each surgery group. Opioid consumption was analyzed in morphine milligram equivalents (MMEs) and is reported in the equivalent number of 5-mg oxycodone tablets.
A total of 119 patients were included in our analysis. The average age was 58 ± 13 years, and 59% of patients were male. Rotator cuff repair was the most frequent surgery (n = 52), followed by arthroplasty (n = 35) and arthroscopy (n = 28). On average, the patients in the study used 82.5 ± 233 MME units, equivalent to 11 ± 31.067 tablets of 5-mg oxycodone. Sixteen percent of patients did not use any opioids. There was no significant difference in opioid consumption or refills across surgery type. In the bivariate analysis for the entire sample, age was the only predictor that was statistically significantly associated with the amount of opioid consumption. In the multivariable model for patient demographics, significant predictors of opioid consumption were age, gender, and pain scores. In the multivariate analysis by surgery type, significant predictors of higher opioid consumption were age, gender, pain score, and surgery performed on the dominant side.
On the basis of the consumption patterns observed in our patient cohort, we recommend prescribing 112.5 MME (15 tablets of 5-mg oxycodone) for arthroscopic shoulder procedures, and 75 MME (10 tablets of 5-mg oxycodone) for shoulder arthroplasties.
处方类阿片类药物滥用已成为美国的一大流行病，也是导致美国人死亡的主要原因之一。术后阿片类药物处方是阿片类药物流行的一个重要因素，在所有专业的医生中，骨科医生是开具阿片类药物处方的第三大群体。我们的目的是回顾性评估接受肩部疾病手术治疗后的总体阿片类药物使用模式，并为标准化术后阿片类药物处方推荐循证指南。
我们对一名接受过单肩/肘 fellowship培训的外科医生（主要研究者）进行的肩关节镜或关节置换术的患者进行了回顾性图表审查。对整个样本的患者和手术特征进行了总结，并根据手术类型进一步分层。比较了每组手术患者在术后首次就诊时的总阿片类药物消耗量和再配药模式。阿片类药物消耗量以吗啡毫克当量（MME）进行分析，并以等效于 5 毫克羟考酮片的数量报告。
共有 119 名患者纳入本分析。平均年龄为 58 ± 13 岁，59%的患者为男性。肩袖修复是最常见的手术（n = 52），其次是关节置换术（n = 35）和关节镜检查（n = 28）。平均而言，研究中的患者使用了 82.5 ± 233 MME 单位，相当于 11 ± 31.067 片 5 毫克羟考酮。16%的患者未使用任何阿片类药物。不同手术类型之间的阿片类药物使用量或再配药无显著差异。在整个样本的单变量分析中，年龄是唯一与阿片类药物使用量呈统计学显著相关的预测因素。在患者人口统计学的多变量模型中，阿片类药物使用量的显著预测因素是年龄、性别和疼痛评分。在按手术类型进行的多变量分析中，阿片类药物使用量较高的显著预测因素是年龄、性别、疼痛评分和在优势侧进行的手术。
根据我们患者队列中的使用模式，我们建议对肩关节镜手术开具 112.5 MME（15 片 5 毫克羟考酮），对肩关节置换术开具 75 MME（10 片 5 毫克羟考酮）。
