Wesselink Elsbeth J, van der Vegt Marinus, Remmelzwaal Sharon, Bossers Sebastiaan M, Franssen Eric J, Swart Eleonora L, Boer Christa, de Leeuw Marcel A
Department of Clinical Pharmacy, Zaans Medisch Centrum, Koningin Julianaplein 58, 1502 DV, Zaandam, The Netherlands.
Amsterdam UMC location Vrije Universiteit Amsterdam, 1117, Anesthesiology, Boelelaan, Amsterdam, The Netherlands.
Patient Saf Surg. 2024 Feb 12;18(1):6. doi: 10.1186/s13037-023-00387-4.
Joint replacement surgery of the lower extremities are common procedures in elderly persons who are at increased risk of postoperative falls. The use of mental state altering medications, such as opioids, antidepressants or benzodiazepines, can further contribute to impaired balance and risk of falls. The objective of the current systematic review was to evaluate the risk of the use of mental state altering medications on postoperative falls in patients undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA).
A comprehensive search of Medline, Embase and Cochrane Controlled Trials Register was conducted from 1 October 1975 to 1 September 2021. The search was repeated in may 2023 and conducted from 1 October 1975 to 1 June 2023. Clinical trials that evaluated the risk of medication on postoperative THA and TKA falls were eligible for inclusion. Articles were evaluated independently by two researchers for risk of bias using the Newcastle-Ottawa Scale. A meta-analysis was performed to determine the potential effect of postoperative use of mental state altering medications on the risk of falls. Lastly, a qualitative synthesis was conducted for preoperative mental state altering medications use.
Seven cohort studies were included, of which five studies focussed on the postoperative use of mental state altering medications and two investigated the preoperative use. Meta-analysis was performed for the postoperative mental state altering medications use. The postoperative use of mental state altering medications was associated with fall incidents (OR: 1.81; 95% CI: 1.04; 3.17) (p < 0.01) after THA and TKA. The preoperative use of opioids > 6 months was associated with a higher risk of fall incidents, whereas a preoperative opioid prescription up to 3 months before a major arthroplasty had a similar risk as opioid-naïve patients.
The postoperative use of mental state altering medications increases the risk of postoperative falls after THA and TKA. Prior to surgery, orthopaedic surgeons and anaesthesiologists should be aware of the associated risks in order to prevent postoperative falls and associated injuries.
下肢关节置换手术在术后跌倒风险增加的老年人中是常见的手术。使用改变精神状态的药物，如阿片类药物、抗抑郁药或苯二氮䓬类药物，会进一步导致平衡受损和跌倒风险增加。本系统评价的目的是评估使用改变精神状态的药物对接受全髋关节置换术（THA）或全膝关节置换术（TKA）患者术后跌倒的风险。
对1975年10月1日至2021年9月1日期间的Medline、Embase和Cochrane对照试验注册库进行了全面检索。2023年5月重复检索，并检索了1975年10月1日至2023年6月1日期间的文献。评估药物对THA和TKA术后跌倒风险的临床试验符合纳入标准。两名研究人员使用纽卡斯尔-渥太华量表独立评估文章的偏倚风险。进行荟萃分析以确定术后使用改变精神状态的药物对跌倒风险的潜在影响。最后，对术前使用改变精神状态的药物进行了定性综合分析。
纳入了七项队列研究，其中五项研究关注术后使用改变精神状态的药物，两项研究术前使用情况。对术后使用改变精神状态的药物进行了荟萃分析。THA和TKA术后使用改变精神状态的药物与跌倒事件相关（OR：1.81；95%CI：1.04；3.17）（p<0.01）。术前使用阿片类药物超过6个月与跌倒事件风险较高相关，而在大关节置换术前3个月内开具的术前阿片类药物处方与未使用阿片类药物的患者风险相似。
THA和TKA术后使用改变精神状态的药物会增加术后跌倒的风险。在手术前，骨科医生和麻醉医生应意识到相关风险，以预防术后跌倒及相关损伤。
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