Ward Ralph, Taber David, Gonzales Haley, Gebregziabher Mulugeta, Basco William, McCauley Jenna, Mauldin Patrick, Ball Sarah
Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA.
Department of Surgery, Medical University of South Carolina, 96 Jonathon Lucas Street CSB 426, Charleston, SC, 29425, USA.
Knee Surg Relat Res. 2022 Apr 5;34(1):18. doi: 10.1186/s43019-022-00148-0.
Opioids are commonly used to manage orthopedic pain in those undergoing total knee arthroplasty (TKA). There are limited studies assessing patterns of perioperative opioid use and risk factors for chronic use in patients undergoing TKA.
This is a retrospective longitudinal cohort study of Medicaid enrollees undergoing TKA between 2014 and 2017 using de-identified medical and pharmacy claims. The primary outcome was chronic opioid use (opioid prescription filled 90-270 days following TKA). Trajectory group membership was determined by identifying distinct groups of patients with similar patterns of daily morphine milligram equivalent (MME) values during the postsurgery follow-up period.
In total, 1666 TKA surgeries performed in 1507 patients were included; 69% of patients were classified as chronic opioid users. Multivariable analyses identified prior opioid use, high opioid doses during the month after TKA, concomitant mood therapies and benzodiazepines, and comorbid conditions as important risk factors. Group-based trajectory analysis identified five distinct post-TKA surgery opioid use phenotypes with several key characteristics predicting group membership.
This large-scale analysis demonstrated that chronic opioid use was common after TKA surgery and established several important risk factors for chronic use following TKA. Novel analysis revealed five distinct opioid use trajectories and identified key characteristics to help guide clinicians when determining perioperative opioid use. Results demonstrate that interventional studies attempting to reduce opioids after TKA are needed if reductions in long-term use are to be realized in this high-risk patient population.
阿片类药物常用于全膝关节置换术（TKA）患者的骨科疼痛管理。评估TKA患者围手术期阿片类药物使用模式及长期使用风险因素的研究有限。
这是一项对2014年至2017年间接受TKA的医疗补助参保者进行的回顾性纵向队列研究，使用匿名的医疗和药房理赔数据。主要结局是长期使用阿片类药物（TKA术后90 - 270天开具阿片类药物处方）。通过识别术后随访期间每日吗啡毫克当量（MME）值模式相似的不同患者组来确定轨迹组成员身份。
共纳入1507例患者进行的1666例TKA手术；69%的患者被归类为长期阿片类药物使用者。多变量分析确定既往使用阿片类药物、TKA术后1个月内高剂量使用阿片类药物、同时使用情绪疗法和苯二氮䓬类药物以及合并症是重要风险因素。基于组的轨迹分析确定了TKA术后阿片类药物使用的五种不同表型，有几个关键特征可预测组成员身份。
这项大规模分析表明，TKA手术后长期使用阿片类药物很常见，并确定了TKA术后长期使用的几个重要风险因素。新的分析揭示了五种不同的阿片类药物使用轨迹，并确定了关键特征，以帮助临床医生在确定围手术期阿片类药物使用时提供指导。结果表明，如果要在这一高风险患者群体中减少长期使用阿片类药物，就需要进行旨在减少TKA后阿片类药物使用的干预性研究。
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