Risk factors for persistent and new chronic opioid use in patients undergoing total hip arthroplasty: a retrospective cohort study.
Risk factors for persistent and new chronic opioid use in patients undergoing total hip arthroplasty: a retrospective cohort study.
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DOI：
10.1136/bmjopen-2015-010664
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发表时间：
2016-04-29
期刊：
影响因子：
2.9
通讯作者：
Roughead EE
中科院分区：
文献类型：
--
作者：
Inacio MC;Hansen C;Pratt NL;Graves SE;Roughead EE
确定THA（全髋关节置换术）前和THA后的长期阿片类药物使用，以及THA后持续或新的长期阿片类药物使用的风险因素。回顾性队列研究。澳大利亚政府退伍军人事务部健康索赔数据库。9525例患者在2001年1月1日至2012年12月31日期间接受了择期单侧THA。长期使用阿片类药物。定义为连续使用阿片类药物90天或非连续使用120天。 THA前，6.2%（n=593）的患者为长期使用者，而THA后为5.2%（n=492）。在492例术后长期使用者中，302例（61%）在THA前后为长期使用者，190例（39%）在术后成为新的长期使用者。持续长期使用的危险因素是年轻（OR=0.96，95% CI 0.93 - 0.99/1年增量），背痛（OR=1.99，95% CI 1.20 - 3.23），糖尿病（OR=3.52，95% CI 1.05 - 11.8），催眠药使用（OR=2.52，95% CI 1.48 - 4.30）和THA前阿片类药物暴露（与阿片类药物使用94-157 天、157-224 天（OR=3.75，95% CI 2.28 - 6.18）、225+天（OR=5.18，95% CI 2.92 - 9.19）相比）。THA术后新的慢性阿片类药物使用的风险因素是女性（OR=1.40，95% CI 1.00 - 1.96），背痛（OR=3.90，95%CI 2.85 ~ 5.33），抑郁（OR=1.70，95% CI 1.20 - 2.41），胃酸疾病（OR=1.62，95% CI 1.16 - 2.25），偏头痛（OR=5.11，95% CI 1.08 - 24.18），肝脏疾病（OR=4.33，95% CI 1.08 - 17.35），体重减轻（OR=2.60，95% CI 1.06 ~ 6.39），痴呆（OR=2.19，95% CI 1.04 - 4.61），血小板增多症（OR=1.38，95% CI 1.00 ~ 1.91）、催眠药（OR=1.56，95% CI 1.13 ~ 2.16）和抗神经性疼痛药物使用（OR=3.11，95% CI 2.05 ~ 4.72）。接受THA的患者长时间暴露于阿片类药物，使他们处于与阿片类药物使用相关的伤害的高风险中。我们确定了慢性阿片类药物使用的风险群体，包括年轻患者和女性，以及慢性阿片类药物使用的可改变的风险因素，包括阿片类药物暴露水平术前和催眠药使用。这些慢性阿片类药物使用的指标可由临床医生用于针对患者群体进行适当的疼痛管理干预。
To determine chronic opioid use pre-THA (total hip arthroplasty) and post-THA, and risk factors for persistent or new chronic opioid use post-THA. Retrospective cohort study. Australian Government Department of Veterans' Affairs health claims database. 9525 patients who had an elective unilateral THA between 1/01/2001 and 12/31/2012. Chronic opioid use. Defined as 90 days of continuous opioid use or 120 days of non-continuous use. Pre-THA, 6.2% (n=593) of patients were chronic users, while 5.2% (n=492) were post-THA. Among the 492 postoperative chronic users, 302 (61%) were chronic users pre-THA and post-THA and 190 (39%) became new chronic users after surgery. Risk factors for persistent chronic use were younger age (OR=0.96, 95% CI 0.93 to 0.99/1-year increment), back pain (OR=1.99, 95% CI 1.20 to 3.23), diabetes (OR=3.52, 95% CI 1.05 to 11.8), hypnotics use (OR=2.52, 95% CI 1.48 to 4.30) and higher pre-THA opioid exposure (compared with opioid use for 94–157 days, 157–224 days (OR=3.75, 95% CI 2.28 to 6.18), 225+ days (OR=5.18, 95% CI 2.92 to 9.19). Risk factors for new chronic opioid use post-THA were being a woman (OR=1.40, 95% CI 1.00 to 1.96), back pain (OR=3.90, 95% CI 2.85 to 5.33), depression (OR=1.70, 95% CI 1.20 to 2.41), gastric acid disease (OR=1.62, 95% CI 1.16 to 2.25), migraine (OR=5.11, 95% CI 1.08 to 24.18), liver disease (OR=4.33, 95% CI 1.08 to 17.35), weight loss (OR=2.60, 95% CI 1.06 to 6.39), dementia (OR=2.19, 95% CI 1.04 to 4.61), hyperlipidaemia (OR=1.38, 95% CI 1.00 to 1.91), hypnotics (OR=1.56, 95% CI 1.13 to 2.16) and antineuropathic pain medication use (OR=3.11, 95% CI 2.05 to 4.72). Patients undergoing THA are exposed to opioids for long periods of time, putting them at high risk of harm related to opioid use. We identified groups at risk of chronic opioid use, including younger patients and women, as well as modifiable risk factors of chronic opioid use, including level of opioid exposure presurgery and hypnotic use. These indicators of chronic opioid use can be used by clinicians to target patient groups for suitable pain management interventions.