School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Pharmacy and Bank Building A15, Science Road, Camperdown, Sydney, NSW, 2006, Australia.
Department of Pharmacy, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
Int J Clin Pharm. 2021 Dec;43(6):1602-1608. doi: 10.1007/s11096-021-01290-7. Epub 2021 Jun 5.
Background The changing of opioids during the transition of care from hospital to home may be associated with harm. Objective To compare patients receiving tapentadol IR versus oxycodone IR following orthopaedic surgery during hospitalisation with regard to the changing of opioids at hospital discharge. Setting A major metropolitan tertiary referral hospital in Australia. Methods This is a retrospective cohort study. Participants included adult orthopaedic surgery patients receiving postoperative tapentadol IR or oxycodone IR during hospitalisation between 1 January 2018 and 30 June 2019. Main outcome measure The proportion of patients for whom the opioid prescribed was changed at hospital discharge. Results The study cohort included 199 patients. Of these, 100 patients received oxycodone and 99 patients received tapentadol post-operatively during hospitalisation. The mean age was 66 years (SD, 12 years) and 111 (56%) were female. The most common surgeries were total knee arthroplasty (91, 46%), total hip arthroplasty (63, 32%) and shoulder surgery (26, 13%). Patients in the tapentadol group were more likely to be changed to a different opioid upon hospital discharge than the oxycodone group (57% versus 9%, difference 48% [95% CI 36-59%, p < 0.01). After adjusting for confounders, post-operative tapentadol use was more likely to be associated with opioid changing upon discharge (OR 16.5, 95% CI 6.7 to 40.8, p < 0.01). Conclusions The post-operative use of tapentadol IR during hospitalisation was associated with an increased likelihood of opioid changing at hospital discharge. This practice could have patient safety implications.
在从医院到家庭的护理过渡期，阿片类药物的更换可能与危害有关。目的：比较骨科手术后住院期间接受曲马多 IR 与羟考酮 IR 的患者在出院时阿片类药物更换情况。地点：澳大利亚主要大都市三级转诊医院。方法：这是一项回顾性队列研究。参与者包括 2018 年 1 月 1 日至 2019 年 6 月 30 日期间在医院接受术后曲马多 IR 或羟考酮 IR 的成年骨科手术患者。主要结局指标：出院时处方阿片类药物改变的患者比例。结果：研究队列包括 199 名患者。其中 100 名患者接受羟考酮，99 名患者接受曲马多术后住院期间。平均年龄为 66 岁（标准差 12 岁），111 名（56%）为女性。最常见的手术是全膝关节置换术（91 例，46%）、全髋关节置换术（63 例，32%）和肩部手术（26 例，13%）。与羟考酮组相比，曲马多组在出院时更有可能更换为不同的阿片类药物（57%对 9%，差异 48%[95%CI 36-59%，p<0.01]）。调整混杂因素后，术后使用曲马多与出院时改变阿片类药物的可能性更大相关（OR 16.5，95%CI 6.7 至 40.8，p<0.01）。结论：住院期间使用曲马多 IR 与出院时阿片类药物更换的可能性增加有关。这种做法可能会对患者安全产生影响。
