Department of Orthopedic Surgery, University of Michigan, Ann Arbor, Michigan.
Department of Surgery, University of Michigan, Ann Arbor, Michigan; Opioid Prescribing Engagement Network, Institute for Health care Policy and Innovation, University of Michigan Ann Arbor, Michigan.
J Arthroplasty. 2023 Jul;38(7 Suppl 2):S130-S137.e3. doi: 10.1016/j.arth.2022.10.038. Epub 2022 Nov 7.
The present study was designed to test the hypothesis that there was no association between initial opioid prescription size and the likelihood of refill after elective primary total knee (TKA) and hip arthroplasty (THA).
We retrospectively analyzed large national datasets of commercial and Medicare insurance claims to identify a weighted cohort of 120,889 primary total joint arthroplasties (76,900 TKA and 43,989 THA) comprised of opioid-naive patients aged 18 to 75 years who had surgery between January 2015 and November 2019. The primary outcome was refill of any prescription opioid medication within 30 days after discharge, and the primary predictor variable was the total amount of opioid filled in the initial discharge prescription measured in oral morphine equivalents (OMEs). Logistic regressions were used to estimate the likelihood of refill, given a particular prescription size while adjusting for multiple patient factors, including age, sex, comorbidities, and year of surgery.
The 30-day refill rate was 59.6% following TKA and 26.1% for THA. Adjusted odds of refill decreased by 2% for every 75 OME (10 tablets of 5 mg oxycodone) increase to the initial prescription size among the THA cohort (adjusted odds ratio [OR] = 0.98; 95% CI 0.97-0.99), and decreased by 3% for the TKA cohort (aOR = 0.97; 95% CI 0.97-0.98).
These nationally representative data demonstrated that larger initial opioid prescription size was associated with small but clinically insignificant decreases in 30-day refill after total joint arthroplasty. This finding should allay concerns about efforts to decrease postsurgical opioid prescribing.
本研究旨在检验以下假设，即初次阿片类药物处方剂量与择期初次全膝关节（TKA）和髋关节置换术（THA）后再配药的可能性之间没有关联。
我们回顾性分析了商业和医疗保险索赔的大型全国性数据集，以确定一个由 120889 例初次全关节置换术（76900 例 TKA 和 43989 例 THA）组成的加权队列，这些患者均为年龄在 18 至 75 岁之间的阿片类药物初治患者，手术时间在 2015 年 1 月至 2019 年 11 月之间。主要结局是在出院后 30 天内再配任何处方阿片类药物，主要预测变量是初始出院处方中填写的阿片类药物总量，以口服吗啡当量（OME）表示。使用逻辑回归来估计在给定特定处方剂量的情况下，考虑到多个患者因素，包括年龄、性别、合并症和手术年份，再配药的可能性。
TKA 后 30 天再配药率为 59.6%，THA 后为 26.1%。THA 队列中，初始处方剂量每增加 75 OME（10 片 5mg 羟考酮），再配药的调整优势比（OR）降低 2%（调整 OR [aOR] = 0.98；95%置信区间 0.97-0.99），TKA 队列降低 3%（aOR = 0.97；95%置信区间 0.97-0.98）。
这些具有全国代表性的数据表明，初次阿片类药物处方剂量越大，全关节置换术后 30 天内再配药的可能性就会略有下降，但临床意义不大。这一发现应该可以消除人们对减少术后阿片类药物处方的担忧。
