From the Hospital for Special Surgery, Adult Reconstruction & Joint Replacement (Premkumar, Krell, and Della Valle), Hospital for Special Surgery, Biostatistics Core (Zhong), Institute for Healthcare Delivery Science, Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai (Liu and Memtsoudis), Hospital for Special Surgery, Department of Anethesiology, Critical Care, and Pain Management, New York, NY (Poeran).
J Am Acad Orthop Surg. 2022 Jan 15;30(2):e213-e222. doi: 10.5435/JAAOS-D-21-00360.
Over the past decade, awareness about opioid abuse in the general community and among prescribers has increased. This study evaluated how opioid prescribing patterns before and after total hip arthroplasty (THA) and total knee arthroplasty (TKA) may have changed during a recent 5-year period.
The Truven Health MarketScan database were queried for patients who underwent elective THA and TKA for primary osteoarthritis between 2013 and 2017. The trend analysis evaluated for changes in opioid prescriptions and multivariate regression identified predictors for chronic postoperative opioid use.
Data were available for 27,908 THA patients and 47,220 TKA patients. The proportion of opioid naïve patients before THA or TKA increased significantly (P < 0.001). Median oral morphine equivalents prescribed during the first postoperative year after THA or TKA decreased significantly (P < 0.001). The proportion of patients with chronic postoperative opioid use also decreased for TKA patients (P < 0.001).
A notable, downward trend was seen in the proportion of patients who received opioids before elective arthroplasty, in the amount of opioid prescribed after surgery, and in TKA patients, the frequency of chronic opioid use after surgery. These findings reflect the effectiveness of efforts to combat the opioid epidemic after elective arthroplasty surgery.
在过去的十年中，公众和医生对阿片类药物滥用的认识有所提高。本研究评估了在最近的五年期间，全髋关节置换术（THA）和全膝关节置换术（TKA）前后的阿片类药物处方模式可能发生了怎样的变化。
通过 Truven Health MarketScan 数据库，检索了 2013 年至 2017 年间因原发性骨关节炎接受择期 THA 和 TKA 的患者。趋势分析评估了阿片类药物处方的变化，多元回归确定了慢性术后阿片类药物使用的预测因素。
THA 患者 27908 例，TKA 患者 47220 例。THA 或 TKA 术前阿片类药物无用药史的患者比例显著增加（P < 0.001）。THA 或 TKA 术后第一年开的口服吗啡等效物中位数显著减少（P < 0.001）。TKA 患者慢性术后阿片类药物使用的比例也有所下降（P < 0.001）。
在接受择期关节置换术的患者中，接受阿片类药物治疗的患者比例、手术后开的阿片类药物剂量以及 TKA 患者手术后慢性使用阿片类药物的频率均出现显著下降，呈显著下降趋势。这些发现反映了在择期关节置换手术后对抗阿片类药物流行方面所做努力的有效性。
