创伤后应激障碍与初次全髋关节置换术后急诊服务增加和阿片类药物处方率相似相关：倾向匹配分析。
Post-Traumatic Stress Disorder Is Associated With Increased Emergency Department Services and Similar Rates of Opioid Prescriptions Following Primary Total Hip Arthroplasty: A Propensity Matched Analysis.
机构信息
Department of Orthopaedics and Rehabilitation, Penn State College of Medicine, Hershey, Pennsylvania.
Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania.
出版信息
J Arthroplasty. 2024 Sep;39(9S2):S287-S292.e1. doi: 10.1016/j.arth.2024.03.012. Epub 2024 Mar 16.
BACKGROUND
There is a paucity of literature regarding patients who have post-traumatic stress disorder (PTSD) following primary total hip arthroplasty (THA). The purpose of this study was to compare the rates of postoperative complications, prescriptions, health care utilization, and revision arthroplasty of patients who had PTSD undergoing primary THA against a propensity matched control group of patients who did not have PTSD (NPTSD).
METHODS
The TriNetX database was queried to identify PTSD patients undergoing primary THA. Patients were then propensity matched in a 1:1 ratio based on twelve preoperative characteristics to a cohort of NPTSD patients. Postoperative prescriptions and rates of health care utilization were analyzed within 5 days, 14 days, and 1 month postoperatively. Complications were analyzed within one month. Revision arthroplasty rates were analyzed within 1 year and 2 years.
RESULTS
A total of 198,560 patients undergoing primary THA were identified. Ultimately, 1,310 PTSD patients were successfully propensity matched to a cohort of 1,310 NPTSD patients. Patients who have PTSD presented to the emergency department at significantly higher rates than NPTSD patients within 14 days and 1 month postoperatively. Within 1 month postoperatively, cohorts were prescribed opioid analgesics at similar rates (P = .709). Patients who had PTSD received more prescriptions per patient compared to NPTSD patients. Patients who had PTSD were also found to have a higher number of total complications per person within 1 month (P = .022). Within 2 years postoperatively, rates of revision hip arthroplasty were comparable between cohorts (P = .912).
CONCLUSIONS
Patients who have PTSD experience similar rates of revision hip arthroplasty and opioid prescribing compared to NPTSD patients following primary THA; however, within 1 month postoperatively, emergency department visits were greater in PTSD patients. These findings can help delineate early postoperative education and expectations for patients who have PTSD in contrast to other psychiatric diagnoses.
背景
鲜有文献报道原发性全髋关节置换术（THA）后并发创伤后应激障碍（PTSD）的患者。本研究旨在比较 PTSD 患者与未患 PTSD（NPTSD）的患者在术后并发症、处方、医疗保健利用和翻修关节成形术方面的发生率。
方法
通过 TriNetX 数据库检索 PTSD 患者行原发性 THA 的病例。然后，根据 12 项术前特征，按照 1:1 的比例对 PTSD 患者进行倾向匹配，与 NPTSD 患者进行匹配。分析术后 5 天、14 天和 1 个月内的处方和医疗保健利用率。术后 1 个月内分析并发症。术后 1 年和 2 年内分析翻修率。
结果
共纳入 198560 例行原发性 THA 的患者。最终，成功对 1310 例 PTSD 患者进行了倾向匹配，得到了 1310 例 NPTSD 患者的匹配队列。与 NPTSD 患者相比，PTSD 患者在术后 14 天和 1 个月内到急诊就诊的比例明显更高。术后 1 个月内，两组患者开阿片类镇痛药的处方率相似（P=0.709）。与 NPTSD 患者相比，PTSD 患者的每位患者开的处方更多。在术后 1 个月内，PTSD 患者的总并发症发生率也更高（P=0.022）。术后 2 年内，两组患者的髋关节翻修率无差异（P=0.912）。
结论
与 NPTSD 患者相比，PTSD 患者在接受原发性 THA 后，翻修髋关节成形术和阿片类药物处方的发生率相似；然而，在术后 1 个月内，PTSD 患者的急诊就诊率更高。这些发现有助于为 PTSD 患者与其他精神诊断患者在术后早期的教育和期望方面提供指导。
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