Division of Allergy and Clinical Immunology, Department of Medicine, Brigham and Women's Hospital, Boston, Mass; Department of Medicine, Harvard Medical School, Boston, Mass.
Department of Medicine, Harvard Medical School, Boston, Mass; Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Mass.
J Allergy Clin Immunol Pract. 2023 Jun;11(6):1891-1898.e3. doi: 10.1016/j.jaip.2023.03.017. Epub 2023 Mar 21.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are indicated for postoperative pain management, but use may be precluded by the report of adverse drug reactions (ADRs). The effect of NSAID ADR labeling on opioid prescribing after total joint arthroplasty (TJA) is unknown.
To assess the association between NSAID ADRs and postoperative opioid prescribing after TJA, a common surgical procedure.
We performed a retrospective cohort study of adults who underwent total joint (knee or hip) replacement in a single hospital network between April, 1, 2016, and December 31, 2019. Demographic information, clinical and surgical characteristics, and prescription data were obtained from the electronic health record. We studied the association between reported NSAID ADRs and postoperative opioid prescribing in a propensity score-matched sample over 1 year of follow-up.
NSAID ADRs were reported by 9.6% of the entire cohort (n = 584/6091). NSAID ADR was associated with 41% higher odds of receipt of opioid prescriptions at 181 to 365 days after hospital discharge (95% confidence interval: 13%-75%) in a propensity score-matched sample. Over 98% of individuals received an opioid prescription at the time of hospital discharge, with no difference in overall median opioid dose prescribed by NSAID ADR status. However, more patients with NSAID ADRs (7.6% vs 4.7%) received cumulative opioid doses ≥ 750 morphine milligram equivalents (MME) at discharge (P = .004).
Reported NSAID ADR was associated with increased risk for prolonged receipt of opioids at 181 to 365 days postoperatively. Patients with NSAID ADRs more frequently received cumulative opioid doses ≥ 750 MME at discharge after TJA. Clarification and evaluation of reported NSAID ADRs may be particularly beneficial for surgical patients at high risk for prolonged receipt of opioids.
非甾体抗炎药（NSAIDs）适用于术后疼痛管理，但由于不良反应（ADR）报告，其使用可能受到限制。NSAID ADR 标签对全关节置换术后（TJA）阿片类药物处方的影响尚不清楚。
评估 NSAID ADR 与 TJA 后术后阿片类药物处方之间的关联，TJA 是一种常见的手术。
我们对 2016 年 4 月 1 日至 2019 年 12 月 31 日期间在单一医院网络中接受全关节（膝关节或髋关节）置换的成年人进行了回顾性队列研究。从电子健康记录中获取人口统计学信息、临床和手术特征以及处方数据。我们在 1 年的随访中，在倾向评分匹配的样本中研究了报告的 NSAID ADR 与术后阿片类药物处方之间的关联。
整个队列中报告有 9.6%（n=584/6091）的患者发生 NSAID ADR。在倾向评分匹配的样本中，NSAID ADR 与出院后 181 至 365 天内接受阿片类药物处方的可能性增加 41%相关（95%置信区间：13%-75%）。超过 98%的人在出院时收到阿片类药物处方，NSAID ADR 状态下开出的阿片类药物总体中位数剂量无差异。然而，更多有 NSAID ADR 的患者（7.6%比 4.7%）在出院时接受了累积阿片类药物剂量≥750 吗啡毫克当量（MME）（P=0.004）。
报告的 NSAID ADR 与术后 181 至 365 天内接受阿片类药物的风险增加相关。有 NSAID ADR 的患者在 TJA 后出院时更频繁地接受累积阿片类药物剂量≥750 MME。澄清和评估报告的 NSAID ADR 可能对高风险接受阿片类药物的手术患者特别有益。
