阿片类药物的使用会增加接受前路颈椎间盘切除融合术患者的假关节形成率和翻修手术率。
Opioid Use Increases the Rate of Pseudarthrosis and Revision Surgery in Patients Undergoing Anterior Cervical Discectomy and Fusion.
作者信息
Lambrechts Mark J, D'Antonio Nicholas D, Heard Jeremy C, Toci Gregory R, Karamian Brian A, Sherman Matthew, Canseco Jose A, Kepler Christopher K, Vaccaro Alexander R, Hilibrand Alan S, Schroeder Gregory D
机构信息
Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA.
出版信息
Global Spine J. 2024 Mar;14(2):620-630. doi: 10.1177/21925682221119132. Epub 2022 Aug 12.
STUDY DESIGN
Retrospective Cohort.
OBJECTIVES
To (1) quantify the risk opioids impart on pseudarthrosis development, (2) analyze the effect of pseudarthrosis on clinical outcomes, and (3) identify if the amount of opioids prescribed are predictive of pseudarthrosis revision.
METHODS
Patients who underwent ACDF at a single institution between 2017-2019 were retrospectively identified. Postoperative dynamic cervical spine radiographs were reviewed to assess fusion status. Logistic regression models measured the effect of morphine milligram equivalents (MME) prescribed on the likelihood of pseudarthrosis development. Receiver operating characteristic (ROC) curves were generated to predict the probability of surgical revision based on MME prescribed.
RESULTS
Of 298 included patients, an average of 2.01 ± 0.82 levels were included in the construct and 121 (40.9%) patients were diagnosed with a pseudarthrosis. However, only 14 (4.7%) required a pseudarthrosis revision. Patients requiring pseudarthrosis revision had worse one-year postoperative Δ PCS-12 (-1.70 vs. 7.58, = 0.004), Δ NDI (3.33 vs. -15.26, = 0.002), and Δ VAS Arm (2.33 vs. -2.48, P = .047). Multivariate logistic regression analyses found the three-month postoperative (OR=1.00, P = .010), one-year postoperative (OR=1.001, P = 0.025), and combined pre- and postoperative MME (OR=1.000, P = .035) increased the risk of pseudarthrosis. ROC analysis identified cutoff values to predict pseudarthrosis revision at 90.00 (area under the curve (AUC): 0.693, confidence interval (CI): 0.554-0.832), 132.86 (0.710, CI: 0.589-0.840), 224.76 (0.687, CI: 0.558-0.817) and 285.00 (0.711, CI: 0.585-0.837) MME in the preoperative, three-month postoperative, one-year postoperative, and combined pre-and postoperative period.
CONCLUSION
Increased prescription of opioid medications following ACDF procedures may increase the risk of pseudarthrosis development and revision surgery.
LEVEL OF EVIDENCE
Therapeutic Level III.
研究设计
回顾性队列研究。
目的
（1）量化阿片类药物对假关节形成的风险；（2）分析假关节对临床结局的影响；（3）确定所开阿片类药物的剂量是否可预测假关节翻修术。
方法
回顾性纳入2017年至2019年在单一机构接受ACDF手术的患者。回顾术后动态颈椎X线片以评估融合状态。逻辑回归模型测量所开吗啡毫克当量（MME）对假关节形成可能性的影响。生成受试者工作特征（ROC）曲线以根据所开MME预测手术翻修的概率。
结果
在纳入的298例患者中，平均每个结构节段包含2.01±0.82个节段，121例（40.9%）患者被诊断为假关节。然而，只有14例（4.7%）需要进行假关节翻修。需要进行假关节翻修的患者术后1年的PCS-12评分变化更差（-1.70对7.58，P=0.004），NDI评分变化更差（3.33对-15.26，P=0.002），VAS上肢评分变化更差（2.33对-2.48，P=0.047）。多因素逻辑回归分析发现术后3个月（OR=1.00，P=0.010）、术后1年（OR=1.001，P=0.025）以及术前和术后MME总和（OR=1.000，P=0.035）会增加假关节形成的风险。ROC分析确定了术前、术后3个月、术后1年以及术前和术后总和MME分别为90.00（曲线下面积（AUC）：0.693，置信区间（CI）：0.554-0.832）、132.86（0.710，CI：0.589-0.840）、224.76（0.687，CI：0.558-0.817）和285.00（0.711，CI：0.585-0.837）时预测假关节翻修的临界值。
结论
ACDF手术后增加阿片类药物的处方可能会增加假关节形成和翻修手术的风险。
证据级别
治疗性三级。
Zotero 插件