Prevalence and risk factors for prolonged opioid use after total joint arthroplasty: a systematic review, meta-analysis, and meta-regression.
Prevalence and risk factors for prolonged opioid use after total joint arthroplasty: a systematic review, meta-analysis, and meta-regression.
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全关节置换术后长期使用阿片类药物的患病率和危险因素：系统评价、荟萃分析和荟萃回归。
DOI：
10.1007/s00402-020-03486-4
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发表时间：
2020
影响因子：
2.3
通讯作者：
Shen Bin
中科院分区：
文献类型：
--
作者：
Wu Limin;Li Mingyang;Zeng Yi;Si Haibo;Liu Yuan;Yang Peng;Shen Bin
阿片类药物是全关节置换术后疼痛治疗的主要药物。TJA后长期使用阿片类药物的患病率和风险因素对于了解以帮助减缓阿片类药物流行非常重要。我们的目的是总结和评估TJA后长期使用阿片类药物的患病率和时间趋势，并汇总其危险因素。MethodsFollowing首选报告项目的系统评价和荟萃分析声明，我们系统地检索PubMed，科克伦图书馆，和EMBASE等。从成立到2019年10月1日。纳入了报告TJA后长期使用阿片类药物（≥ 3个月）风险因素的队列研究。提取并合成了研究特征、风险比（RR）和长期使用阿片类药物的患病率。ResultsA在2015年至2019年期间共发表了15项研究，包括416，321例患者。12% [95%CI 10-14%]的患者在TJA后长期使用阿片类药物，其时间趋势与中位入组年数相关（P= 0.0013）。既往阿片类药物使用（RR = 1.73;P< 0.001），创伤后应激障碍（RR = 1.34;P< 0.001），苯二氮卓类药物使用（RR = 1.38;P< 0.001），烟草滥用（RR = 1.26;P< 0.001），纤维肌痛（RR = 1.51;P< 0.001），背痛（RR = 1.34; P< 0.001）是阿片类药物长期使用的最大有效危险因素。这是第一个确定长期使用阿片类药物的风险因素并描述其在TJA中的比率和时间趋势的荟萃分析。了解长期使用阿片类药物可能性较高的患者的风险因素可用于实施适当的管理策略，减少不安全的阿片类药物处方，并降低TJA后长期使用阿片类药物的风险。
PurposeOpioids are a mainstay for pain management after total joint arthroplasty (TJA). The prevalence and risk factors for prolonged opioid use after TJA are important to understand to help slow the opioid epidemic. We aim to summarize and evaluate the prevalence and time trend of prolonged opioid use after TJA and pool its risk factors.MethodsFollowing the preferred reporting items for systematic reviews and meta-analysis statement, we systematically searched PubMed, the Cochrane Library, and EMBASE, etc. from inception up to October 1, 2019. Cohort studies reporting risk factors for prolonged opioids use (≥ 3 months) after TJA were included. Studies characteristics, risk ratios (RR), and prevalence of prolonged opioid use were extracted and synthesized.ResultsA total of 15 studies were published between 2015 and 2019, with 416,321 patients included. 12% [95%CI 10–14%] of patients had prolonged opioid use after TJA and its time trend was associated with median enrollment years (P= 0.0013). Previous opioid use (RR = 1.73;P< 0.001), post-traumatic stress disorder (RR = 1.34;P< 0.001), benzodiazepine use (RR = 1.38;P< 0.001), tobacco abuse (RR = 1.26;P< 0.001), fibromyalgia (RR = 1.51;P< 0.001), and back pain (RR = 1.34;P< 0.001) were the largest effective risk factors for prolonged use of opioids.ConclusionsTo our knowledge, this is the first meta-analysis determining the risk factors of prolonged opioid use and characterizing its rate and time trend in TJA. Understanding risk factors for patients with higher potential for prolonged opioids use can be used to implement appropriate management strategies, reduce unsafe opioid prescriptions, and decrease the risk of prolonged opioid use after TJA.