服务地点的变化导致密歇根州初次全髋关节和膝关节置换患者的阿片类药物处方增加，这是一项密歇根关节置换登记协作质量改进计划质量研究。

Site of Service Changes Have Resulted in Increased Opioid Prescriptions for Primary Total Hip and Knee Patients in Michigan, a Michigan Arthroplasty Registry Collaborative Quality Initiative Quality Study.

作者信息

Uppal Harjot, Markel David, Melone Giresse, Puri Simarjeet, Chen Lisheng, Kim Tae, Hallstrom Brian, Hughes Richard, Dailey Elizabeth

机构信息

Section of Orthopaedic Surgery, Henry Ford Providence Hospital, Southfield, MI, USA.

The Core Institute, Novi, MI, USA.

出版信息

Arthroplast Today. 2025 Jul 12;34:101771. doi: 10.1016/j.artd.2025.101771. eCollection 2025 Aug.

DOI:10.1016/j.artd.2025.101771

PMID:40697893

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12280335/

Abstract

BACKGROUND

The Michigan Arthroplasty Registry Collaborative Quality Initiative (MARCQI) successfully changed opioid prescribing patterns by instituting guidelines for total hip (THAs) and knee arthroplasties (TKAs). Given Medicare changes, cases are moving to ambulatory surgery centers (ASCs) and hospital outpatient departments (HOPDs). We aimed to assess whether these sites adopted the well-proven opioid recommendations.

METHODS

Using data from the Michigan Arthroplasty Registry Collaborative Quality Initiative, all opioid-naïve (no prescription within 30 days) patients undergoing primary total joint arthroplasty between July 1, 2021, and June 30, 2022, were identified. Of the 12,962 THAs: 11.0% (1425) were in ASCs, 5.2% (674) in HOPDs, and 84% (10,863) in hospitals. Of the 20,092 primary TKAs: 10.3% (2064) were in ASCs, 4.5% (906) in HOPDs, and 85.2% (17,122) in hospitals.

RESULTS

The cohorts were statistically different, with unhealthier patients within the hospital population. For THAs and TKAs, ASCs had the highest mean oral morphine equivalents at discharge, 239 (±109.9) and 307.4 (±151.9), compared to hospitals and HOPDs ( < .05). Overall, HOPDs had the lowest oral morphine equivalent for THA ( < .05), while HOPDs and Hospitals had similar levels for TKAs ( = .27). ASCs had the lowest compliance rate for both THA (56%) and TKA(69%) compared to HOPDs (89%, 80%) and hospitals (83%, 87%) ( < .05), respectively.

CONCLUSIONS

ASC and HOPDs patients are selected for the ability to be discharged home. Yet opioid-naïve total joint arthroplasty patients at Michigan ASCs received more opioids at discharge compared to patients undergoing the same procedures at HOPDs and hospitals.

摘要

背景

密歇根关节置换登记协作质量倡议（MARCQI）通过制定全髋关节置换术（THAs）和膝关节置换术（TKAs）的指南，成功改变了阿片类药物的处方模式。鉴于医疗保险政策的变化，病例正转向门诊手术中心（ASCs）和医院门诊部（HOPDs）。我们旨在评估这些机构是否采用了经过充分验证的阿片类药物推荐方案。

方法

利用密歇根关节置换登记协作质量倡议的数据，确定了2021年7月1日至2022年6月30日期间所有初次接受全关节置换术且未使用过阿片类药物（30天内无处方）的患者。在12962例全髋关节置换术中：11.0%（1425例）在门诊手术中心，5.2%（674例）在医院门诊部，84%（10863例）在医院。在20092例初次膝关节置换术中：10.3%（2064例）在门诊手术中心，4.5%（906例）在医院门诊部，85.2%（17122例）在医院。

结果

各队列在统计学上存在差异，医院人群中的患者健康状况较差。对于全髋关节置换术和膝关节置换术，门诊手术中心出院时的平均口服吗啡当量最高，分别为239（±109.9）和307.4（±151.9），高于医院和医院门诊部（P<0.05）。总体而言，医院门诊部全髋关节置换术的口服吗啡当量最低（P<0.05），而医院门诊部和医院膝关节置换术的水平相似（P = 0.27）。与医院门诊部（89%，80%）和医院（83%，87%）相比，门诊手术中心全髋关节置换术（56%）和膝关节置换术（69%）的依从率最低（P<0.05）。