Opioid Use Following Inpatient Versus Outpatient Total Joint Arthroplasty
Opioid Use Following Inpatient Versus Outpatient Total Joint Arthroplasty
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DOI：
10.2106/jbjs.20.01401
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发表时间：
2021-03-17
影响因子：
5.3
通讯作者：
Chen, Antonia F.
中科院分区：
文献类型：
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作者：
Varady, Nathan H.;Smith, Eric L.;Chen, Antonia F.
工作背景：尽管对住院患者全关节置换术（TJA）后继续使用阿片类药物的风险进行了充分研究，但门诊患者的这些风险尚不清楚。本研究的目的是描述门诊患者与住院患者TJA后阿片类药物使用的特征。研究方法：在这项回顾性队列研究中，在一个大型的国家商业索赔保险数据库中确定了2007年至2017年接受住院或门诊（不过夜）主要选择性TJA的阿片类药物初治患者。为了纳入研究，患者必须在TJA手术前连续入组数据库≥ 12个月和术后≥ 6个月。利用控制人口统计学、地理、手术、年份和合并症的多变量分析来确定手术环境与持续使用阿片类药物风险之间的关联，持续使用阿片类药物定义为患者在术后>90天仍在服用新的阿片类药物处方。结果：我们共确定了92，506例阿片类药物初治TJA患者，其中57，183例（61.8%）接受了全膝关节置换术（TKA）。总体而言，7，342例患者（7.9%）接受了门诊TJA手术，包括4，194例门诊TKA。门诊患者TJA与手术阿片类药物处方减少相关（78.9%，而住院手术为87.6%; p < 0.001）。在80,393名患者中（86.9%）接受手术阿片类药物的患者，（以吗啡毫克当量计）（中位数，750;四分位数范围，450至1，200）和门诊手术（中位数，750;四分位距，450 - 1，140; p = 0.47）;然而，住院TJA患者在术后90天后仍服用阿片类药物的可能性明显更大（11.4%，而门诊手术为9.0%; p < 0.001）。这些结果在校正分析中持续存在（校正比值比，1.13; 95%置信区间，1.03 - 1.24; p = 0.01）。结论：接受阿片类药物处方的门诊TJA患者的阿片类药物处方量与接受住院TJA手术的患者相似，但即使在控制患者因素时，也不太可能成为持续的阿片类药物使用者。与住院TJA相比，门诊TJA似乎不是新阿片类药物依赖的风险因素，这些发现支持继续向低风险患者的门诊TJA模式过渡。
Background: Although the risks of continued opioid use following inpatient total joint arthroplasty (TJA) have been well-studied, these risks in the outpatient setting are not well known. The purpose of the present study was to characterize opioid use following outpatient compared with inpatient TJA. Methods: In this retrospective cohort study, opioid-naive patients who underwent inpatient or outpatient (no overnight stay) primary, elective TJA from 2007 to 2017 were identified within a large national commercial-claims insurance database. For inclusion in the study, patients had to have been continuously enrolled in the database for >= 12 months prior to and >= 6 months after the TJA procedure. Multivariable analyses controlling for demographics, geography, procedure, year, and comorbidities were utilized to determine the association between surgical setting and risk of persistent opioid use, defined as the patient still filling new opioid prescriptions >90 days postoperatively. Results: We identified a total of 92,506 opioid-naive TJA patients, of whom 57,183 (61.8%) underwent total knee arthroplasty (TKA). Overall, 7,342 patients (7.9%) underwent an outpatient TJA procedure, including 4,194 outpatient TKAs. Outpatient TJA was associated with reduced surgical opioid prescribing (78.9% compared with 87.6% for inpatient procedures; p < 0.001). Among the 80,393 patients (86.9%) who received surgical opioids, the total amount of opioids prescribed (in morphine milligram equivalents) was similar between inpatient (median, 750; interquartile range, 450 to 1,200) and outpatient procedures (median, 750; interquartile range, 450 to 1,140; p = 0.47); however, inpatient TJA patients were significantly more likely to still be taking opioids after 90 days postoperatively (11.4% compared with 9.0% for outpatient procedures; p < 0.001). These results persisted in adjusted analysis (adjusted odds ratio, 1.13; 95% confidence interval, 1.03 to 1.24; p = 0.01). Conclusions: Outpatient TJA patients who received opioid prescriptions were prescribed a similar amount of opioids as those undergoing inpatient TJA procedures, but were significantly less likely to become persistent opioid users, even when controlling for patient factors. Outpatient TJA, as compared with inpatient TJA, does not appear to be a risk factor for new opioid dependence, and these findings support the continued transition to the outpatient-TJA model for lower-risk patients.