Manjunath Amit K, Bloom David A, Fried Jordan W, Bieganowski Thomas, Slover James D, Macaulay William B, Schwarzkopf Ran
Department of Orthopedic Surgery, NYU Langone Health, New York, USA.
Department of Orthopedic Surgery, NYU Langone Health, New York, USA.
Knee. 2023 Aug;43:106-113. doi: 10.1016/j.knee.2023.06.003. Epub 2023 Jun 27.
Prior research has demonstrated that the prescription of opioid medications may be associated with the desire to treat pain in order to achieve favorable patient satisfaction. The purpose of the current study was to investigate the effect of decreased opioid prescribing following total knee arthroplasty (TKA) on survey-administered patient satisfaction scores.
This study is a retrospective review of prospectively collected survey data for patients who underwent primary elective TKA for the treatment of osteoarthritis (OA) between September 2014 and June 2019. All patients included had completed Hospital Consumer Assessment of Healthcare Providers and Systems (HCAPS) survey information. Patients were stratified into two cohorts based on whether their surgery took place prior to or subsequent to the implementation of an institutional-wide opioid-sparing regimen.
Of the 613 patients included, 488 (80%) were in the pre-protocol cohort and 125 (20%) in the post-protocol cohort. Rate of opioid refills (33.6% to 11.2%; p < 0.001) as well as length of stay (LOS, 2.40 ± 1.05 to 2.13 ± 1.13 days; p = 0.014) decreased significantly after protocol change while rate of current smokers increased significantly (4.1% to 10.4%; p = 0.011). No significant difference was observed in "top box" percentages for satisfaction with pain control (Pre: 70.5% vs Post: 72.8%; p = 0.775).
Protocols calling for reduced prescription of opioids following TKA resulted in significantly lower rates of opioid refills, and were associated with significantly shorter LOS, while causing no statistically significant deleterious changes in patient satisfaction, as measured by HCAPS survey. LOE: III.
This study suggests that HCAPS scores are not negatively impacted by a reduction in postoperative opioid analgesics.
先前的研究表明，开具阿片类药物处方可能与为了获得良好的患者满意度而治疗疼痛的意愿有关。本研究的目的是调查全膝关节置换术（TKA）后减少阿片类药物处方对通过问卷调查得出的患者满意度评分的影响。
本研究是对2014年9月至2019年6月期间因骨关节炎（OA）接受初次择期TKA治疗的患者前瞻性收集的调查数据进行的回顾性分析。纳入的所有患者均已完成医疗服务提供者和系统的医院消费者评估（HCAPS）调查信息。根据手术是在全机构范围的阿片类药物节约方案实施之前还是之后进行，将患者分为两个队列。
在纳入的613例患者中，488例（80%）在方案前队列，125例（20%）在方案后队列。方案改变后，阿片类药物再填充率（从33.6%降至11.2%；p<0.001）以及住院时间（LOS，从2.40±1.05天降至2.13±1.13天；p=0.014）显著降低，而当前吸烟者的比例显著增加（从4.1%增至10.4%；p=0.011）。在疼痛控制满意度的“最高等级”百分比方面未观察到显著差异（术前：70.5% vs术后：72.8%；p=0.775）。
要求TKA后减少阿片类药物处方的方案导致阿片类药物再填充率显著降低，且与住院时间显著缩短相关，同时通过HCAPS调查衡量，患者满意度没有统计学上的显著有害变化。证据等级：III级。
本研究表明，术后阿片类镇痛药的减少不会对HCAPS评分产生负面影响。
