Schmidt Shawna, Shrian-Chang Kuang, Silva Susan, Goode Victoria, Horn Maggie, Cary Michael P
Shawna Schmidt, BSN, RN, SRNA, Nurse Anesthesia Student, Duke University School of Nursing, Durham, NC.
Kuang Shrian-Chang, BSN, RN, SRNA, Nurse Anesthesia Student, Duke University School of Nursing, Durham, NC.
Orthop Nurs. 2021;40(6):366-374. doi: 10.1097/NOR.0000000000000808.
The United States is facing an opioid epidemic that has only worsened with the COVID-19 pandemic. There is little evidence regarding patterns of opioid use among patients with total hip replacement (THR). Although the Centers for Disease Control and Prevention has put forward guidelines for prescribing opioids, it does not include guidance specifically for THR patients suffering from presurgical and postsurgical pain. The purpose of this study was to (1) compare presurgical and postsurgical opioid rates, (2) compare presurgical and postsurgical morphine milligram equivalents (MME), and (3) determine whether having a presurgical opioid prescription predicts the receipt of postsurgical opioid prescriptions among patients undergoing THR surgery. Retrospective cohort analysis of 4,405 patients undergoing THR at a major academic medical center in the United States from April 30, 2015, to April 30, 2018, was done. Patient characteristics, opioid rates, and average MME/day/person were described. Logistic regression was used to determine whether presurgical opioid prescription and opioid risk level predicted postsurgical opioid prescribing. Median age was 64 years (range = 18-85 years); patients were primarily Caucasian/White (78.8%) and female (54.7%). Opioid prescription rates in this sample for the 12-month presurgical and postsurgical periods were 66.1% and 95.6%, respectively. Oxycodone was the most common opioid prescribed in both periods. Among those prescribed an opioid, moderate/high risk for overdose and/or death was 6.3% presurgery and 19.8% postsurgery. Patients with a comorbidity were two times more likely to receive an opioid prescription in the postsurgical period. The median average MME/day/person was 26.5 (range = 0.3-180.0) for patients with an opioid prescribed during the presurgery period and 40.4 (range = 1.5-270.0) during the postsurgery period. Opioid use, regardless of strength, in the presurgical period as well as having one or more comorbidities predicted opioid use in the postsurgical period.
美国正面临一场阿片类药物泛滥的危机，而新冠疫情更是让这一情况雪上加霜。关于全髋关节置换术（THR）患者的阿片类药物使用模式，目前几乎没有相关证据。尽管美国疾病控制与预防中心已经出台了阿片类药物处方指南，但其中并未包含专门针对遭受术前和术后疼痛的THR患者的指导意见。本研究的目的是：（1）比较术前和术后的阿片类药物使用率；（2）比较术前和术后的吗啡毫克当量（MME）；（3）确定术前开具阿片类药物处方是否能预测接受THR手术患者术后阿片类药物处方的获取情况。对2015年4月30日至2018年4月30日期间在美国一家大型学术医疗中心接受THR手术的4405例患者进行了回顾性队列分析。描述了患者特征、阿片类药物使用率以及每人每天的平均MME。采用逻辑回归分析来确定术前阿片类药物处方和阿片类药物风险水平是否能预测术后阿片类药物处方情况。患者的中位年龄为64岁（范围 = 18 - 85岁）；患者主要为白种人/白人（78.8%），女性占54.7%。该样本中术前和术后12个月的阿片类药物处方率分别为66.1%和95.6%。羟考酮是两个时期最常用的阿片类药物。在开具了阿片类药物的患者中，术前过量用药和/或死亡的中度/高风险为6.3%，术后为19.8%。患有合并症的患者在术后接受阿片类药物处方的可能性是其他人的两倍。术前开具阿片类药物处方的患者每人每天的平均MME中位数为26.5（范围 = 0.3 - 180.0），术后为40.4（范围 = 1.5 - 270.0）。术前使用阿片类药物，无论其强度如何，以及患有一种或多种合并症，均能预测术后的阿片类药物使用情况。
