The perioperative effects of chronic preoperative opioid use on shoulder arthroplasty outcomes
The perioperative effects of chronic preoperative opioid use on shoulder arthroplasty outcomes
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DOI：
10.1016/j.jse.2017.05.016
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发表时间：
2017-11-01
影响因子：
3
通讯作者：
Zhang, Alan L.
中科院分区：
文献类型：
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作者：
Cheah, Jonathan W.;Sing, David C.;Zhang, Alan L.
假设和背景：慢性阿片类药物治疗是骨关节炎相关疼痛治疗中越来越多使用的方式。我们假设，慢性阿片类药物的使用将与肩关节置换术的不良结局相关。方法：回顾性分析2012-2015年在一家机构接受择期解剖型全肩关节置换术（TSA）和反向全肩关节置换术（rTSA）的患者。患者分层术前阿片类药物的使用（非用户，短效阿片类药物的用户，长效阿片类药物的用户），他们的术后临床outcomes进行了assessed.Results：我们确定了262例（170 rTSA和92解剖TSA），其中138例术前使用阿片类药物（82%短效和18%长效）。当比较非阿片类药物使用者、短效阿片类药物使用者和长效阿片类药物使用者时，术前使用阿片类药物的患者在术后住院期间给予的吗啡当量平均总毫克数显著较高（分别为66.9 mg、111.4 mg和208.3 mg; P <0.001）。此外，术后视觉模拟量表疼痛评分在术后第0天（分别为2.6、3.2和3.9; P = .007）、第1天（分别为4.0、4.9和6.0; P < .001）和第2天（分别为3.0、3.9和5.1; P < .001）较高。阿片类药物的使用与住院时间、并发症或再入院率的显著增加无关。对于完成2年随访的患者，阿片类药物使用者和非阿片类药物使用者组表现出类似的术后改善美国肩肘外科医生肩关节scores.Conclusion：肩关节成形术前阿片类药物使用的术前病史与围手术期阿片类药物消耗和视觉模拟量表评分显着较高。然而，与接受全膝关节或髋关节置换术的患者不同，术前阿片类药物使用与住院时间增加，围手术期并发症或肩关节置换术90天再入院率无关。(C)2017肩肘外科杂志董事会。All rights reserved.
Hypothesis and background: Chronic opioid therapy is an increasingly used modality for the treatment of osteoarthritis-associated pain. We hypothesized that chronic opioid use would be associated with adverse outcomes in shoulder arthroplasty.Methods: A retrospective analysis of patients undergoing elective anatomic total shoulder arthroplasty (TSA) and reverse total shoulder arthroplasty (rTSA) at a single institution from 2012-2015 was performed. Patients were stratified by preoperative opioid use (nonusers, short-acting opioid users, and long-acting opioid users), and their postoperative clinical outcomes were assessed.Results: We identified 262 patients (170 rTSA and 92 anatomic TSA), of whom 138 were using opioids preoperatively (82% short acting and 18% long acting). When non-opioid users, short-acting opioid users, and long-acting opioid users were compared, mean total milligrams of morphine equivalents administered during postoperative hospitalization was significantly higher for those with preoperative opioid use (66.9 mg, 111.4 mg, and 208.3 mg, respectively; P < .001). In addition, postoperative visual analog scale pain scores were higher on postoperative day 0 (2.6, 3.2, and 3.9, respectively; P = .007), day 1 (4.0, 4.9, and 6.0, respectively; P < .001), and day 2 (3.0, 3.9, and 5.1, respectively; P < .001). Opioid use was not associated with a significantly increased hospital length of stay, complications, or readmission rates. For patients who completed 2-year follow-up, both the opioid user and non-opioid user groups demonstrated similarly improved postoperative American Shoulder and Elbow Surgeons shoulder scores.Conclusion: A preoperative history of opioid use before shoulder arthroplasty was associated with significantly higher perioperative opioid consumption and visual analog scale scores. However, unlike in patients undergoing total knee or hip arthroplasty, preoperative opioid use was not associated with increased hospital length of stay, perioperative complications, or 90-day readmission rates for shoulder arthroplasty. (C) 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.