From the Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA (Ross, Sherman), the Department of Orthopaedic Surgery, University of Texas, McGovern School of Medicine at UTHealth, Houston, TX (Wu, Mansour), the Department of Orthopaedic Surgery, LSUHSC School of Medicine, New Orleans, LA (Lee).
J Am Acad Orthop Surg. 2021 Dec 1;29(23):e1254-e1263. doi: 10.5435/JAAOS-D-20-01184.
The United States is experiencing a national opioid epidemic. This study seeks to analyze recent trends in opioid claims after elective total joint arthroplasty and quantify the effect of preoperative opioid use on risk of prolonged postoperative claim rates.
A retrospective cohort study was conducted using the PearlDiver database to track annual trends in opioid claims after elective total hip arthroplasty (THA), total knee arthroplasty (TKA), and total shoulder arthroplasty (TSA). Trend analysis of opioid claim rates was done with the Cochran-Armitage test. Rates of postoperative opioid claims were compared between opioid-naïve patients versus patients with opioid claims in the preoperative year through multivariable logistic regression.
In total, 105,860 procedures were included. For all procedures, the proportion of patients filing an opioid claim within 30 days postoperatively trended upward from 2011 to 2017 (all P < 0.001). Patients with one to three opioid claims in the year before arthroplasty were more likely to file an opioid claim within 30 days after arthroplasty (THA: odds ratio [OR], 2.61; TKA: OR, 3.04; and TSA: OR, 4.83), between 31 and 90 days (THA: OR, 2.76; TKA: OR, 2.87; and TSA: OR, 3.22), and between 91 days and 6 months (THA: OR, 4.83; TKA: OR, 4.07; and TSA: OR, 3.77). Patients with more than three prior opioid claims were more likely to file an opioid claim within 30 days (THA: OR, 6.15; TKA: OR, 6.79; and TSA: OR, 8.68), between 31 and 90 days (THA: OR, 20.99; TKA: OR, 14.00; and TSA: OR, 28.40), and between 91 days and 6 months (THA: OR, 46.31; TKA: OR, 33.93; and TSA: OR, 59.06).
Opioid claims in the preoperative year markedly increase risk of prolonged postoperative opioid claims after arthroplasty. Surgeons should look further before the acute preoperative period when evaluating opioid exposure and assessing risk of chronic opioid dependence after elective arthroplasty.
Level III.
美国正在经历一场全国性的阿片类药物泛滥。本研究旨在分析择期全关节置换术后阿片类药物索赔的近期趋势，并量化术前阿片类药物使用对延长术后索赔率的影响。
本研究使用 PearlDiver 数据库进行回顾性队列研究，以跟踪择期全髋关节置换术（THA）、全膝关节置换术（TKA）和全肩关节置换术（TSA）后阿片类药物索赔的年度趋势。使用 Cochran-Armitage 检验进行阿片类药物索赔率的趋势分析。通过多变量逻辑回归比较术前一年无阿片类药物索赔的患者与有阿片类药物索赔的患者术后阿片类药物索赔的发生率。
共纳入 105860 例手术。对于所有手术，术后 30 天内提交阿片类药物索赔的患者比例从 2011 年到 2017 年呈上升趋势（均 P<0.001）。在术前一年有一到三次阿片类药物索赔的患者在关节置换术后 30 天内提交阿片类药物索赔的可能性更高（THA：比值比[OR]，2.61；TKA：OR，3.04；TSA：OR，4.83），31 至 90 天（THA：OR，2.76；TKA：OR，2.87；TSA：OR，3.22），91 至 6 个月（THA：OR，4.83；TKA：OR，4.07；TSA：OR，3.77）。有三次以上既往阿片类药物索赔的患者在 30 天内提交阿片类药物索赔的可能性更高（THA：OR，6.15；TKA：OR，6.79；TSA：OR，8.68），31 至 90 天（THA：OR，20.99；TKA：OR，14.00；TSA：OR，28.40），91 至 6 个月（THA：OR，46.31；TKA：OR，33.93；TSA：OR，59.06）。
术前一年的阿片类药物索赔显著增加了关节置换术后延长术后阿片类药物索赔的风险。在评估择期关节置换术后慢性阿片类药物依赖的风险时，外科医生应在急性术前阶段之前进一步评估阿片类药物暴露情况。
III 级。
