Meade Patrick J, Matzko Chelsea N, Stamm Michaela A, Mulcahey Mary K
Tulane University School of Medicine, New Orleans, Louisiana, U.S.A.
Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana, U.S.A.
Arthrosc Sports Med Rehabil. 2023 Jul 8;5(4):100758. doi: 10.1016/j.asmr.2023.100758. eCollection 2023 Aug.
To report rates of preoperative and postoperative opioid use between male and female patients and to identify risk factors for extended opioid use following anterior cruciate ligament reconstruction (ACLR).
Patients undergoing ACLR between 2011 and 2018 were identified from the PearlDiver database. The opioid refill rates for males vs females were compared at monthly intervals for 1 year after ACLR. Patients who filled an opioid prescription <3 months before surgery were classified as opioid users, while those who had never filled one were classified as nonopioid users.
Of 106,995 ACLR patients, 37,890 (35.4%) were opioid users <3 months before surgery, and 37,554 (35.1%) had never filled an opioid prescription. Of the preoperative opioid users, 20,413 (53.9%) were female and 17,477 (46.1%) were male ( < .001). Postoperatively, females were at higher risk of filling an opioid prescription at each monthly interval, except for the first month after surgery. The refill rate for opioid users was also higher than that for nonopioid users at each monthly interval after ACLR. In addition to patient sex, a preoperative diagnosis of anxiety/depression, low back pain, myalgia, a history of drug dependence, alcohol abuse, and tobacco use increased a patient's risk of filling an opioid prescription postoperatively.
This study demonstrated that females are significantly more likely to be opioid users than males prior to ACLR and are more likely to continue to refill an opioid prescription in the year following surgery. Multiple risk factors were associated with prolonged postoperative opioid utilization, including female sex, anxiety/depression, low back pain, myalgia, a history of drug dependence, alcohol abuse, and tobacco use.
Level III, retrospective cohort study.
报告男性和女性患者术前及术后阿片类药物的使用情况，并确定前交叉韧带重建术（ACLR）后长期使用阿片类药物的风险因素。
从PearlDiver数据库中识别出2011年至2018年间接受ACLR的患者。在ACLR术后1年，按月比较男性和女性的阿片类药物再填充率。术前3个月内开具过阿片类药物处方的患者被归类为阿片类药物使用者，而从未开具过此类处方的患者则被归类为非阿片类药物使用者。
在106,995例ACLR患者中，37,890例（35.4%）在术前3个月内为阿片类药物使用者，37,554例（35.1%）从未开具过阿片类药物处方。在术前阿片类药物使用者中，女性有20,413例（53.9%），男性有17,477例（46.1%）（P<0.001）。术后，除了术后第一个月外，女性在每个月开具阿片类药物处方的风险都更高。ACLR术后每个月，阿片类药物使用者的再填充率也高于非阿片类药物使用者。除了患者性别外，术前诊断为焦虑/抑郁、腰痛、肌痛、药物依赖史、酗酒和吸烟会增加患者术后开具阿片类药物处方的风险。
本研究表明，在ACLR术前，女性比男性更有可能是阿片类药物使用者，并且在术后一年更有可能继续再填充阿片类药物处方。多种风险因素与术后长期使用阿片类药物有关，包括女性性别、焦虑/抑郁、腰痛、肌痛、药物依赖史、酗酒和吸烟。
III级，回顾性队列研究。
