Bourgeault-Gagnon Yoan, Khalik Hassaan Abdel, Patel Mansi, Simunovic Nicole, Ayeni Olufemi R
Department of Surgery, Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada.
Knee Surg Sports Traumatol Arthrosc. 2024 Jul;32(7):1854-1861. doi: 10.1002/ksa.12204. Epub 2024 May 7.
The purpose of the study was to identify prognostic risk factors for prolonged opioid use at 2 and 6 weeks after hip arthroscopy using data from the Femoroacetabular Impingement RandomiSed controlled Trial and its external validation cohort study.
Opioids were prescribed for postoperative pain management at the surgeon's discretion, with a majority being prescribed a combination of oxycodone and paracetamol (5/325 mg). Prolonged opioid use was defined as the ongoing use of any dosage of opioids reported at either 2 or 6 weeks after surgery to treat femoroacetabular impingement, as recorded in the patient's study medication log. Multivariable logistic regressions were performed to evaluate patient and surgical characteristics, such as preoperative opioid use, type of surgical procedure and intraoperative cartilage state that may be associated with prolonged opioid use at either 2 and 6 weeks postoperatively.
A total of 265 and 231 patients were included for analysis at 2 and 6 weeks postoperatively, respectively. The median age of participants was 35 years (interquartile range [IQR]: 27-42) and 33% were female. At 2 weeks postoperatively, female sex (odds ratio [OR]: 2.56; 95% confidence interval: [CI] 1.34-4.98, p = 0.005), higher body mass index (BMI) (OR: 1.10; 95% CI: 1.02-1.18, p = 0.009), active tobacco use (OR: 4.06; 95% CI: 1.90-8.97, p < 0.001), preoperative opioid use (OR: 10.1; 95% CI: 3.25-39.1, p < 0.001) and an Outerbridge classification of ≥3 (OR: 2.33; 95% CI: 1.25-4.43, p = 0.009) were significantly associated with prolonged opioid use. At 6 weeks postoperatively, only preoperative opioid use was significantly associated with prolonged opioid consumption (OR: 10.6; 95% CI: 3.60-32.6, p < 0.001).
Preoperative opioid use was significantly associated with continued opioid use at 2 and 6 weeks postoperatively. Specific patient factors including female sex, higher BMI, active tobacco use and more severe cartilage damage should be considered in developing targeted strategies to limit opioid use after surgery.
Level III.
本研究旨在利用股骨髋臼撞击症随机对照试验及其外部验证队列研究的数据，确定髋关节镜检查后2周和6周时长期使用阿片类药物的预后风险因素。
阿片类药物由外科医生酌情开出处方用于术后疼痛管理，大多数患者使用的是羟考酮和对乙酰氨基酚（5/325毫克）的组合。长期使用阿片类药物的定义为，如患者研究用药记录中所记录的，术后2周或6周时持续使用任何剂量的阿片类药物来治疗股骨髋臼撞击症。进行多变量逻辑回归分析，以评估患者和手术特征，如术前阿片类药物使用情况、手术类型和术中软骨状态，这些因素可能与术后2周和6周时长期使用阿片类药物有关。
分别有265例和231例患者纳入术后2周和6周时的分析。参与者的中位年龄为35岁（四分位间距[IQR]：27 - 42），33%为女性。术后2周时，女性（优势比[OR]：2.56；95%置信区间：[CI] 1.34 - 4.98，p = 0.005）、较高的体重指数（BMI）（OR：1.10；95% CI：1.02 - 1.18，p = 0.009）、当前吸烟（OR：4.06；95% CI：1.90 - 8.97，p < 0.001）、术前使用阿片类药物（OR：10.1；95% CI：3.25 - 39.1，p < 0.001）以及Outerbridge分级≥3（OR：2.33；95% CI：1.25 - 4.43，p = 0.009）与长期使用阿片类药物显著相关。术后6周时，仅术前使用阿片类药物与长期使用阿片类药物显著相关（OR：10.6；95% CI：3.60 - 32.6，p < 0.001）。
术前使用阿片类药物与术后2周和6周时持续使用阿片类药物显著相关。在制定限制术后阿片类药物使用的针对性策略时，应考虑包括女性、较高BMI、当前吸烟以及更严重的软骨损伤等特定患者因素。
三级。
