Department of Orthopaedic Surgery, Corewell Health/Michigan State University, Grand Rapids, Michigan.
The CORE Institute, Novi, Michigan.
J Arthroplasty. 2023 Jul;38(7):1245-1250. doi: 10.1016/j.arth.2023.01.013. Epub 2023 Feb 23.
Excessive opioid prescriptions after total joint arthroplasty (TJA) increase risks for adverse opioid-related events, chronic opioid use, and unlawful opioid diversion. Decreasing postoperative prescriptions may improve quality after TJA. Concerns exist that a decrease in opioids prescribed may increase complications, such as readmissions, emergency department (ED) visits, or worsened patient-reported outcomes (PROs). The purpose of this study was to explore whether a reduction in opioids prescribed after TJA resulted in increased complications.
Data originated from a statewide database prospectively abstracted, including oral morphine equivalents prescribed at discharge, readmissions, ED visits, and PROs. Data were collected from 84,998 TJA occurring 1 year before and after the creation of an opioid-prescribing protocol that had decreased prescriptions by approximately 50%. Trends were monitored using Shewhart control charts. Regression models were used to determine statistically significant changes over time.
All groups showed a reduction in opioids prescribed by almost 50% without an increase in emergency room visits or readmissions and without a detrimental effect on PROs. Compared to baseline data before opioid reduction, opioid-naive total knee arthroplasty had significant improvements in all outcomes (P = .03, P = .02, P < .001, P < .001). Opioid-tolerant total knee arthroplasty and total hip arthroplasty had no worsened outcomes and significant improvement in (Knee Injury and Osteoarthritis Outcome score for Joint Replacement P = .03) and (Hip Disability and Osteoarthritis Outcome Score for Joint Replacement P = .03). Opioid-naive total hip arthroplasty had significant improvements in Hip Disability and Osteoarthritis Outcome Score Joint Replacement (P = .003) and Patient Reported Outcomes Measurement Information System (P = .001).
Postoperative opioid prescription recommendations from a statewide registry decreased prescribing by approximately 50% without decreasing PROs or increasing ED visits or readmissions. A reduction in opioids prescribed after TJA can be accomplished safely and without increased complications.
全关节置换术后（TJA）过度开具阿片类药物处方会增加不良阿片类药物相关事件、慢性阿片类药物使用和非法阿片类药物转移的风险。减少术后处方可能会改善 TJA 后的质量。人们担心，减少开具的阿片类药物可能会增加并发症，如再入院、急诊就诊或患者报告的结局恶化（PROs）。本研究旨在探讨 TJA 后减少阿片类药物处方是否会导致并发症增加。
数据源自前瞻性提取的全州数据库，包括出院时开具的口服吗啡等效物、再入院、急诊就诊和 PROs。数据收集自 TJA 术后 1 年，在创建减少处方约 50%的阿片类药物处方方案之前和之后。使用休哈特控制图监测趋势。使用回归模型确定随时间的统计学显著变化。
所有组都显示处方阿片类药物减少了近 50%，而急诊就诊或再入院没有增加，PROs 也没有受到不利影响。与阿片类药物减少前的基线数据相比，阿片类药物未耐受的全膝关节置换术在所有结局方面都有显著改善（P=0.03，P=0.02，P<0.001，P<0.001）。阿片类药物耐受的全膝关节置换术和全髋关节置换术没有恶化的结局，并且在（膝关节损伤和骨关节炎结果评分用于关节置换 P=0.03）和（髋关节残疾和骨关节炎结果评分用于关节置换 P=0.03）方面有显著改善。阿片类药物未耐受的全髋关节置换术在髋关节残疾和骨关节炎结果评分关节置换方面有显著改善（P=0.003）和患者报告的结果测量信息系统（P=0.001）。
来自全州登记处的术后阿片类药物处方推荐减少了约 50%的处方，而没有降低 PROs 或增加急诊就诊或再入院。TJA 后减少阿片类药物的处方可以安全地完成，而不会增加并发症。
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