Li Neill Y, Kuczmarski Alexander S, Hresko Andrew M, Goodman Avi D, Gil Joseph A, Daniels Alan H
Department of Orthopaedic Surgery, Alpert Medical School of Brown University, Providence, Rhode Island, United States.
J Hand Microsurg. 2020 Aug 5;14(2):163-169. doi: 10.1055/s-0040-1715426. eCollection 2022 Apr.
This article compares opioid use patterns following four-corner arthrodesis (FCA) and proximal row carpectomy (PRC) and identifies risk factors and complications associated with prolonged opioid consumption. The PearlDiver Research Program was used to identify patients undergoing primary FCA (Current Procedural Terminology [CPT] codes 25820, 25825) or PRC (CPT 25215) from 2007 to 2017. Patient demographics, comorbidities, perioperative opioid use, and postoperative complications were assessed. Opioids were identified through generic drug codes while complications were defined by International Classification of Diseases, Ninth and Tenth Revisions, Clinical Modification codes. Multivariable logistic regressions were performed with < 0.05 considered statistically significant. A total of 888 patients underwent FCA and 835 underwent PRC. Three months postoperatively, more FCA patients (18.0%) continued to use opioids than PRC patients (14.7%) ( = 0.033). Preoperative opioid use was the strongest risk factor for prolonged opioid use for both FCA (odds ratio [OR]: 4.91; < 0.001) and PRC (OR: 6.33; < 0.001). Prolonged opioid use was associated with an increased risk of implant complications (OR: 4.96; < 0.001) and conversion to total wrist arthrodesis (OR: 3.55; < 0.001) following FCA. Prolonged postoperative opioid use is more frequent in patients undergoing FCA than PRC. Understanding the prevalence, risk factors, and complications associated with prolonged postoperative opioid use after these procedures may help physicians counsel patients and implement opioid minimization strategies preoperatively.
本文比较了四角融合术（FCA）和近排腕骨切除术（PRC）后的阿片类药物使用模式，并确定了与长期使用阿片类药物相关的风险因素和并发症。使用PearlDiver研究计划来识别2007年至2017年接受初次FCA（当前程序编码[CPT]：25820、25825）或PRC（CPT 25215）的患者。评估了患者的人口统计学特征、合并症、围手术期阿片类药物使用情况和术后并发症。通过通用药物编码识别阿片类药物，而并发症则由《国际疾病分类》第九版和第十版临床修订版编码定义。进行多变量逻辑回归分析，P<0.05被认为具有统计学意义。共有888例患者接受了FCA，835例接受了PRC。术后三个月，继续使用阿片类药物的FCA患者（18.0%）比PRC患者（14.7%）更多（P = 0.033）。术前使用阿片类药物是FCA（优势比[OR]：4.91；P<0.001）和PRC（OR：6.33；P<0.001）长期使用阿片类药物的最强风险因素。FCA术后长期使用阿片类药物与植入物并发症风险增加（OR：4.96；P<0.001）和转为全腕关节融合术风险增加（OR：3.55；P<0.001）相关。FCA术后患者术后长期使用阿片类药物比PRC患者更频繁。了解这些手术后与术后长期使用阿片类药物相关的患病率、风险因素和并发症，可能有助于医生为患者提供咨询，并在术前实施阿片类药物最小化策略。
