Perioperative Use of Gabapentinoids and Risk for Postoperative Long-Term Opioid Use in Older Adults Undergoing Total Knee or Hip Arthroplasty.
Perioperative Use of Gabapentinoids and Risk for Postoperative Long-Term Opioid Use in Older Adults Undergoing Total Knee or Hip Arthroplasty.
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DOI：
10.1016/j.arth.2022.05.018
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发表时间：
2022-11
影响因子：
3.5
通讯作者：
Wei, Yu-Jung
中科院分区：
文献类型：
--
作者：
Chen, Cheng;Tighe, Patrick J.;Lo-Ciganic, Wei-Hsuan;Winterstein, Almut G.;Wei, Yu-Jung
关键词：
指南建议加巴喷丁类药物作为多模式镇痛的一部分，以管理术后疼痛并减少阿片类药物的使用。目前尚不清楚围手术期使用加巴喷丁类药物是否与全膝关节或髋关节置换术（TKA/THA）后术后长期使用阿片类药物（LTOU）的风险降低或增加相关。使用2011年至2018年的医疗保险索赔数据，我们确定了年龄≥ 65岁的付费服务受益人，他们因初次TKA/THA住院，并且在手术前没有LTOU。从入院前7天到出院后7天测量围手术期加巴喷丁类药物的使用情况。要求患者在围手术期接受阿片类药物治疗，并从出院后第7天起随访180天，以评估术后LTOU（即，≥连续90天）。采用改良Poisson回归估计围手术期使用与未使用加巴喷丁类药物的患者术后LTOU的相对风险（RR），通过倾向评分加权调整混杂因素。在52，788名符合条件的Medicare老年受益人中（平均标准差[SD]年龄72.7 [5.3]; 62.5%为女性; 89.7%为白色），3，967名（7.5%）在围手术期接受了加巴喷丁类药物。术后LTOU为3.8%的患者和4.0%的患者没有围手术期加巴喷丁类。在调整混杂因素后，术后LTOU的风险与未使用围手术期加巴喷丁类药物的患者相似（RR = 1.07; 95%置信区间[CI] 0.91-1.26，P = 0.408）。敏感性和偏倚分析得出了一致的结果。在接受初次TKA/THA的老年医疗保险受益人中，围手术期使用加巴喷丁类药物与术后LTOU风险降低或增加无关。
Gabapentinoids are recommended by guidelines as a component of multimodal analgesia to manage postoperative pain and reduce opioid use. It remains unknown whether perioperative use of gabapentinoids is associated with a reduced or increased risk of postoperative long-term opioid use (LTOU) after total knee or hip arthroplasty (TKA/THA). Using Medicare claims data from 2011 to 2018, we identified fee-for-service beneficiaries aged ≥ 65 years who were hospitalized for a primary TKA/THA and had no LTOU before the surgery. Perioperative use of gabapentinoids was measured from 7 days preadmission through 7 days postdischarge. Patients were required to receive opioids during the perioperative period and were followed from day 7 postdischarge for 180 days to assess postoperative LTOU (ie, ≥90 consecutive days). A modified Poisson regression was used to estimate the relative risk (RR) of postoperative LTOU in patients with versus without perioperative use of gabapentinoids, adjusting for confounders through propensity score weighting. Of 52,788 eligible Medicare older beneficiaries (mean standard deviation [SD] age 72.7 [5.3]; 62.5% females; 89.7% White), 3,967 (7.5%) received gabapentinoids during the perioperative period. Postoperative LTOU was 3.8% in patients with and 4.0% in those without perioperative gabapentinoids. After adjusting for confounders, the risk of postoperative LTOU was similar comparing patients with versus without perioperative gabapentinoids (RR = 1.07; 95% confidence interval [CI] 0.91–1.26, P = .408). Sensitivity and bias analyses yielded consistent results. Among older Medicare beneficiaries undergoing a primary TKA/THA, perioperative use of gabapentinoids was not associated with a reduced or increased risk for postoperative LTOU.
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DOI：
10.1136/bmj.g1251
发表时间：
2014-02-11
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Clarke H;Soneji N;Ko DT;Yun L;Wijeysundera DN
通讯作者：
Wijeysundera DN
影响因子：
5.1
作者：
Hsia HL;Takemoto S;van de Ven T;Pyati S;Buchheit T;Ray N;Wellman S;Kuo A;Wallace A;Raghunathan K
通讯作者：
Raghunathan K
影响因子：
5.7
作者：
Hah JM;Bateman BT;Ratliff J;Curtin C;Sun E
通讯作者：
Sun E
DOI：
10.1161/circoutcomes.113.000359
发表时间：
2013-09-01
期刊：
Circulation. Cardiovascular quality and outcomes
影响因子：
--
作者：
Brookhart MA;Wyss R;Layton JB;Stürmer T
通讯作者：
Stürmer T
影响因子：
13.8
作者：
Lawal, Oluwadolapo D.;Gold, Justin;Wen, Xuerong
通讯作者：
Wen, Xuerong