Kristiansen Eskild Bendix, Pedersen Alma B
Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
Acta Orthop. 2025 Sep 2;96:664-670. doi: 10.2340/17453674.2025.44572.
Long-term opioid therapy (LTOT) has frequently been reported in patients undergoing total hip or knee arthroplasty (THA or KA). However, there is no clear recommendation on the definition. We aimed to evaluate the sensitivity of the estimated risk of LTOT and association with mortality after THA and KA to the selection among 14 different candidate LTOT definitions.
Using data from the nationwide Danish registries, we included patients with osteoarthritis undergoing primary THA during 2016-2019 (n = 28,957) or KA during 2014-2020 (n = 51,239). We obtained individual-level information on opioid prescriptions from any pharmacy 1 year before and 1 year after surgery. 14 common LTOT definitions were selected from the literature. The primary outcome was the variation in the 1-year crude risk of LTOT corresponding to variation in LTOT definition. Analysis was done overall and stratified by sex, age, prior opioid use, and year of surgery. The secondary outcome was the 4-year mortality among patients meeting each LTOT definition.
The 1-year risk of LTOT varied from 1.2% (95% confidence interval [CI] 1.1-1.3) to 20.1% (CI 19.6-20.5) for THA and 0.2% (CI 0.1-0.2) to 29.6% (CI 29.2-30.0) for KA patients depending on definition. For THA or KA, women had a higher risk of LTOT than men for all definitions, thus, LTOT varies from 0.2% (CI 0.1-0.2) to 32.9% (CI 32.3-33.4) for women and from 0.1% (CI 0.1-0.2) to 24.9% (24.4-25.5) for men. With increasing age risks of LTOT were steady or slightly decreasing. There was a decrease in the risk of LTOT from 2016 to 2019 for all definitions. 4-year mortality in patients meeting LTOT definitions varied from 9.8% (CI 8.9-10.7) to 16.3% (CI 13.2-20.1) for THA and 6.9% (CI 6.4-7.4) to 10.5% (CI 8.5-12.9) for KA patients.
The estimation of the risk of LTOT after THA or KA and association with mortality is strongly dependent on the definition of LTOT used by researchers. This highlights the limitation on the comparability of opioid studies assessing risk and prognosis in these patients.
全髋关节或膝关节置换术（THA或KA）患者长期使用阿片类药物治疗（LTOT）的情况屡有报道。然而，对于其定义尚无明确建议。我们旨在评估LTOT估计风险的敏感性，以及THA和KA后LTOT与死亡率的关联，以确定14种不同候选LTOT定义的选择。
利用丹麦全国登记处的数据，我们纳入了2016 - 2019年期间接受初次THA的骨关节炎患者（n = 28,957）或2014 - 2020年期间接受KA的患者（n = 51,239）。我们获取了手术前1年和手术后1年来自任何药房的阿片类药物处方的个体水平信息。从文献中选择了14种常见的LTOT定义。主要结局是对应于LTOT定义变化的LTOT 1年粗风险的变化。总体进行分析，并按性别、年龄、既往阿片类药物使用情况和手术年份分层。次要结局是符合每个LTOT定义的患者的4年死亡率。
根据定义，THA患者LTOT的1年风险从1.2%（95%置信区间[CI] 1.1 - 1.3）到20.1%（CI 19.6 - 20.5）不等，KA患者从0.2%（CI 0.1 - 0.2）到29.6%（CI 29.2 - 30.0）不等。对于THA或KA，所有定义下女性LTOT的风险均高于男性，因此，女性LTOT的风险从0.2%（CI 0.1 - 0.2）到32.9%（CI 32.3 - 33.4）不等，男性从0.1%（CI 0.1 - 0.2）到24.9%（24.4 - 25.5）不等。随着年龄的增加，LTOT的风险稳定或略有下降。所有定义下，2016年至2019年LTOT的风险均有所降低。符合LTOT定义的患者4年死亡率，THA患者从9.8%（CI 8.9 - 10.7）到16.3%（CI 13.2 - 20.1）不等，KA患者从6.9%（CI 6.4 - 7.4）到10.5%（CI 8.5 - 12.9）不等。
THA或KA后LTOT风险的估计以及与死亡率的关联强烈依赖于研究人员使用的LTOT定义。这凸显了评估这些患者风险和预后的阿片类药物研究在可比性方面的局限性。
