Adams Alexander J, Paladino Joseph, Townsend Clay, Ilyas Asif M
Department of Orthopedic Surgery, Rothman Institute at Thomas Jefferson University, Philadelphia, PA.
Rothman Opioid Foundation, Philadelphia, PA.
J Hand Surg Glob Online. 2022 Jan 10;4(2):78-83. doi: 10.1016/j.jhsg.2021.12.008. eCollection 2022 Mar.
Thumb basal joint arthroplasty surgery is a common hand surgery after which patients often require opioids. To better understand safe opioid consumption patterns, this study sought to identify risk factors for filling a second prescription and/or prolonged opioid use (prescription over 6 months after the surgery). Preoperative opioid use was hypothesized to show an association with greater postoperative opioid use.
A retrospective review of consecutive patients who underwent primary thumb basal joint arthroplasty was conducted, yielding 110 patients for analysis. Demographic and clinical data were collected. Opioid prescription data were extracted from 6 months before the surgery to 9 months after the surgery using a state prescription drug monitoring program. Bivariate and multivariate analyses were performed for filling a second opioid prescription or filling an opioid prescription over 6 months after the surgery.
All the patients filled their initial postoperative prescription. Of the 110 patients, 26.4% filled an opioid prescription before the surgery, 42% filled a second postoperative prescription, and 14.5% were still consuming opioids over 6 months after the surgery. Patients using preoperative opioids had 7-fold higher odds of filling a second opioid prescription and 37-fold higher odds of prolonged use. No other demographic or clinical factors, including the type of procedure or number of initial opioids prescribed, were associated with increased use of postoperative opioids. Of all the opioid prescriptions filled after the initial postoperative prescription, only 9.3% were prescribed by a surgeon's office.
Patients who undergo thumb basal joint arthroplasty with preoperative opioid use have much greater odds of filling a second opioid prescription and prolonged use after the surgery. Low initial surgeon-provided opioid dosages did not correlate to filling a second prescription, indicating that lower initial doses are feasible. Finally, nearly all opioid-naïve patients who filled a second opioid prescription received them from providers other than a surgeon, indicating the need for greater communication with nonsurgical providers simultaneously caring for patients in the perioperative period.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic III.
拇指基底关节置换术是一种常见的手部手术，术后患者通常需要使用阿片类药物。为了更好地了解安全的阿片类药物使用模式，本研究旨在确定开具第二张处方和/或长期使用阿片类药物（手术后6个月以上的处方）的风险因素。术前使用阿片类药物被假设与术后更多地使用阿片类药物有关。
对接受初次拇指基底关节置换术的连续患者进行回顾性研究，共纳入110例患者进行分析。收集了人口统计学和临床数据。使用州处方药监测程序从手术前6个月至手术后9个月提取阿片类药物处方数据。对开具第二张阿片类药物处方或手术后6个月以上开具阿片类药物处方进行了双变量和多变量分析。
所有患者都填写了术后初始处方。在110例患者中，26.4%在手术前开具了阿片类药物处方，42%开具了术后第二张处方，14.5%在手术后6个月以上仍在使用阿片类药物。术前使用阿片类药物的患者开具第二张阿片类药物处方的几率高7倍，长期使用的几率高37倍。没有其他人口统计学或临床因素，包括手术类型或初始开具的阿片类药物数量，与术后阿片类药物使用增加有关。在术后初始处方之后开具的所有阿片类药物处方中，只有9.3%是由外科医生办公室开具的。
术前使用阿片类药物的拇指基底关节置换术患者开具第二张阿片类药物处方和术后长期使用的几率要高得多。外科医生最初提供的阿片类药物低剂量与开具第二张处方无关，这表明较低的初始剂量是可行的。最后，几乎所有初次未使用阿片类药物但开具了第二张阿片类药物处方的患者都是从非外科医生那里获得的，这表明在围手术期需要与同时照顾患者的非手术医生进行更多沟通。
研究类型/证据水平：治疗性III级。
