Department of Anesthesiology, Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA.
School of Medicine, Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD, 20814, USA.
Arch Orthop Trauma Surg. 2023 Sep;143(9):5539-5548. doi: 10.1007/s00402-023-04853-7. Epub 2023 Apr 1.
Optimized health system approaches to improving guideline-congruent care require evaluation of multilevel factors associated with prescribing practices and outcomes after total knee and hip arthroplasty.
Electronic health data from patients who underwent a total knee or hip arthroplasty between January 2016-January 2020 in the Military Health System Data were retrospectively analyzed. A generalized linear mixed-effects model (GLMM) examined the relationship between fixed covariates, random effects, and the primary outcome (30-day opioid prescription refill).
In the sample (N = 9151, 65% knee, 35% hip), the median discharge morphine equivalent dose was 660 mg [450, 892] and varied across hospitals and several factors (e.g., joint, race and ethnicity, mental and chronic pain conditions, etc.). Probability of an opioid refill was higher in patients who underwent total knee arthroplasty, were white, had a chronic pain or mental health condition, had a lower age, and received a presurgical opioid prescription (all p < 0.01). Sex assigned in the medical record, hospital duration, discharge non-opioid prescription receipt, discharge morphine equivalent dose, and receipt of an opioid-only discharge prescription were not significantly associated with opioid refill.
In the present study, several patient-, care-, and hospital-level factors were associated with an increased probability of an opioid prescription refill within 30 days after arthroplasty. Future work is needed to identify optimal approaches to reduce unwarranted and inequitable healthcare variation within a patient-centered framework.
优化医疗体系方法以改善指南一致的护理需要评估与全膝关节和髋关节置换术后处方实践和结果相关的多层次因素。
回顾性分析了 2016 年 1 月至 2020 年 1 月期间在军人健康系统数据中接受全膝关节或髋关节置换术的患者的电子健康数据。广义线性混合效应模型（GLMM）检查了固定协变量、随机效应与主要结果（30 天内阿片类药物处方补充）之间的关系。
在样本（N=9151，65%为膝关节，35%为髋关节）中，出院时吗啡当量中位数为 660mg[450,892]，并在医院和几个因素（如关节、种族和民族、精神和慢性疼痛状况等）之间存在差异。接受全膝关节置换术、为白人、患有慢性疼痛或精神健康状况、年龄较低以及接受术前阿片类药物处方的患者，开具阿片类药物补充处方的可能性更高（均 P<0.01）。病历中分配的性别、住院时间、出院时非阿片类药物处方的接受情况、出院时吗啡当量和接受阿片类药物出院处方与阿片类药物补充之间没有显著相关性。
在本研究中，患者、护理和医院层面的几个因素与术后 30 天内开具阿片类药物处方补充的可能性增加有关。需要进一步研究，以确定在以患者为中心的框架内减少不必要和不公平的医疗保健差异的最佳方法。
