Ingall Eitan, Klemt Christian, Melnic Christopher M, Cohen-Levy Wayne B, Tirumala Venkatsaiakhil, Kwon Young-Min
Department of Orthopaedic Surgery, Bioengineering Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
J Knee Surg. 2023 Jan;36(2):115-120. doi: 10.1055/s-0041-1729966. Epub 2021 May 15.
This is a retrospective study. Prior studies have characterized the deleterious effects of narcotic use in patients undergoing primary total knee arthroplasty (TKA). While there is an increasing revision arthroplasty burden, data on the effect of narcotic use in the revision surgery setting remain limited. Our aim was to characterize the effect of active narcotic use at the time of revision TKA on patient-reported outcome measures (PROMs). A total of 330 consecutive patients who underwent revision TKA and completed both pre- and postoperative PROMs was identified. Due to differences in baseline characteristics, 99 opioid users were matched to 198 nonusers using the nearest-neighbor propensity score matching. Pre- and postoperative knee disability and osteoarthritis outcome score physical function (KOOS-PS), patient reported outcomes measurement information system short form (PROMIS SF) physical, PROMIS SF mental, and physical SF 10A scores were evaluated. Opioid use was identified by the medication reconciliation on the day of surgery. Propensity score-matched opioid users had significantly lower preoperative PROMs than the nonuser for KOOS-PS (45.2 vs. 53.8, < 0.01), PROMIS SF physical (37.2 vs. 42.5, < 0.01), PROMIS SF mental (44.2 vs. 51.3, < 0.01), and physical SF 10A (34.1 vs. 36.8, < 0.01). Postoperatively, opioid-users demonstrated significantly lower scores across all PROMs: KOOS-PS (59.2 vs. 67.2, < 0.001), PROMIS SF physical (43.2 vs. 52.4, < 0.001), PROMIS SF mental (47.5 vs. 58.9, < 0.001), and physical SF 10A (40.5 vs. 49.4, < 0.001). Propensity score-matched opioid-users demonstrated a significantly smaller absolute increase in scores for PROMIS SF Physical ( = 0.03) and Physical SF 10A ( < 0.01), as well as an increased hospital length of stay ( = 0.04). Patients who are actively taking opioids at the time of revision TKA report significantly lower preoperative and postoperative outcome scores. These patients are more likely to have longer hospital stays. The apparent negative effect on patient reported outcomes after revision TKA provides clinically useful data for surgeons in engaging patients in a preoperative counseling regarding narcotic use prior to revision TKA to optimize outcomes.
这是一项回顾性研究。既往研究已描述了麻醉药物使用对初次全膝关节置换术（TKA）患者的有害影响。虽然翻修关节成形术的负担日益增加，但关于麻醉药物使用在翻修手术中的影响的数据仍然有限。我们的目的是描述翻修TKA时使用活性麻醉药物对患者报告结局指标（PROMs）的影响。共确定了330例连续接受翻修TKA并完成术前和术后PROMs的患者。由于基线特征存在差异，使用最近邻倾向评分匹配法将99例阿片类药物使用者与198例非使用者进行匹配。评估术前和术后的膝关节功能障碍和骨关节炎结局评分身体功能（KOOS-PS）、患者报告结局测量信息系统简表（PROMIS SF）身体、PROMIS SF心理和身体SF 10A评分。通过手术当天的用药核对来确定阿片类药物的使用情况。倾向评分匹配的阿片类药物使用者在术前KOOS-PS（45.2对53.8，<0.01）、PROMIS SF身体（37.2对42.5，<0.01）、PROMIS SF心理（44.2对51.3，<0.01）和身体SF 10A（34.1对36.8，<0.01）方面的PROMs显著低于非使用者。术后，阿片类药物使用者在所有PROMs中的得分均显著较低：KOOS-PS（59.2对67.2，<0.001）、PROMIS SF身体（43.2对52.4，<0.001）、PROMIS SF心理（47.5对58.9，<0.001）和身体SF 10A（40.5对49.4，<0.001）。倾向评分匹配的阿片类药物使用者在PROMIS SF身体（=0.03）和身体SF 10A（<0.01）得分的绝对增加明显较小，且住院时间延长（=0.04）。在翻修TKA时正在积极服用阿片类药物的患者报告的术前和术后结局评分显著较低。这些患者更有可能住院时间更长。翻修TKA后对患者报告结局的明显负面影响为外科医生在翻修TKA前就麻醉药物使用对患者进行术前咨询以优化结局提供了临床有用的数据。
