骨科多发伤患者慢性阿片类药物使用的患病率及风险
Prevalence and risk of chronic opioid use in orthopaedic polytrauma patients.
作者信息
Held Michael E, Otwell Alex G, Cherney Steven M, Stambough Jeffery B, Bowman Stephen M, Mears Simon C
机构信息
Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, 4301 W. Markham Drive, Little Rock, AR, 72205, USA.
Department of General Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, 722205, USA.
出版信息
Arch Orthop Trauma Surg. 2025 Apr 17;145(1):248. doi: 10.1007/s00402-025-05864-2.
INTRODUCTION
Prolonged opioid usage has numerous side effects, contributing to poorer long-term outcomes. An unexplored area pertains to patient-specific factors that influence chronic opioid consumption in cases of multiple fractures. We aimed to assess the prevalence and identify risk factors for chronic opioid usage in orthopedic polytrauma patients.
MATERIALS AND METHODS
We retrospectively identified 167 patients who sustained multiple lower extremity fractures occurring at a level-one trauma between July 2017 and June 2020. Utilizing the state prescription monitoring database, we gathered opioid prescription data for 3 months before and one year following the surgical procedure.
RESULTS
In total, 68 patients (41%) exhibited chronic opioid use after trauma. Of the 167 patients, 38 (22.7%) engaged in pre-admission opioid usage, of which 28 patients (73.7%) displayed chronic usage after discharge. Pre-admission opioid use (odds ratio 9.02, P = < 0.001) and an Injury Severity Score (ISS) greater than 15 (odds ratio 3.62, P = 0.007) increased the odds of chronic usage compared to those without these risk factors. The chronic use group had significantly more surgeries performed on average (mean 4 vs. 2.9; P = 0.015) and a higher frequency of open fractures (P = 0.017). Polytrauma patients that obtained greater amounts of Morphine Milligram Equivalents (MMEs) before, during, and after admission, were statistically more likely to become chronic opioid users.
CONCLUSIONS
Chronic opioid use is common after polytrauma. Polytrauma patients with pre-admission opioid use, a higher ISS, and escalated opioid requirements during hospitalization should be closely monitored for long-term opioid use. Sustained endeavors to mitigate opioid consumption and enhance non-opioid approaches are essential in preventing long-term challenges secondary to chronic opioid usage in polytrauma patients.
LEVEL OF EVIDENCE
Prognostic Level 2 Retrospective Cohort.
引言
长期使用阿片类药物有诸多副作用，会导致较差的长期预后。一个尚未探索的领域涉及影响多发性骨折患者慢性阿片类药物消费的患者特定因素。我们旨在评估骨科多发伤患者慢性阿片类药物使用的患病率并确定其危险因素。
材料与方法
我们回顾性地确定了2017年7月至2020年6月期间在一级创伤中心发生多发性下肢骨折的167例患者。利用州处方监测数据库，我们收集了手术前3个月和手术后1年的阿片类药物处方数据。
结果
总共有68例患者（41%）在创伤后出现慢性阿片类药物使用情况。在167例患者中，38例（22.7%）在入院前使用阿片类药物，其中28例患者（73.7%）出院后出现慢性使用情况。与没有这些危险因素的患者相比，入院前使用阿片类药物（比值比9.02，P < 0.001）和损伤严重程度评分（ISS）大于15（比值比3.62，P = 0.007）会增加慢性使用的几率。慢性使用组平均进行的手术明显更多（平均4次对2.9次；P = 0.015），开放性骨折的发生率更高（P = 0.017）。在入院前、入院期间和入院后获得更高吗啡毫克当量（MME）的多发伤患者在统计学上更有可能成为慢性阿片类药物使用者。
结论
多发伤后慢性阿片类药物使用很常见。对于入院前使用阿片类药物、ISS较高且住院期间阿片类药物需求增加的多发伤患者，应密切监测其长期阿片类药物使用情况。持续努力减少阿片类药物消费并加强非阿片类方法对于预防多发伤患者慢性阿片类药物使用继发的长期挑战至关重要。
证据水平
预后水平2回顾性队列研究。
Zotero 插件