Impact of Postoperative Opioid Use on 2-Year Patient-Reported Outcomes in Knee Surgery Patients.
Impact of Postoperative Opioid Use on 2-Year Patient-Reported Outcomes in Knee Surgery Patients.
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膝关节手术患者术后使用阿片类药物对 2 年患者报告结果的影响。
DOI：
10.1055/s-0040-1722326
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发表时间：
2022
期刊：
影响因子：
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通讯作者：
Henn3rd,RFrank
中科院分区：
文献类型：
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作者：
Song,Xuyang;Sajak,PatrickMJ;Aneizi,Ali;Alqazzaz,Aymen;Burt,CameranI;Ventimiglia,DominicJ;Meredith,SeanJ;Leong,NatalieL;Packer,JonathanD;Henn3rd,RFrank
本研究的目的是确定与膝关节手术后再填充术后阿片类药物处方相关的患者特征，并确定再填充阿片类药物是否与2年患者报告的结局相关。我们假设术后阿片类药物再灌注与患者报告的2年结局较差相关。我们研究了192例在一个城市学术机构接受膝关节手术的患者。患者在术前和术后2年完成了多项患者报告结局指标，包括6个患者报告结局测量信息系统（PROMIS）领域、国际膝关节文献委员会（IKDC）问卷、手术膝关节和身体其他部位的数字疼痛量表评分、马克思活动评定量表以及满足预期、改善和满意度指标。根据区域处方监测计划计算总吗啡当量（TME）。将重新填充术后阿片类药物处方的患者与未重新填充的患者进行比较，并计算重新填充患者的TME（重新填充TME）。129名患者（67%）至少重新填写了一份术后阿片类药物处方。黑人种族、年龄较大、平均体重指数（BMI）较高、吸烟、合并症较多、术前阿片类药物使用、收入较低、政府保险和膝关节置换术与再填充阿片类药物相关。更大的再填充TME与黑人或白色种族、年龄较大、平均BMI较高、吸烟、更多的医疗合并症、术前阿片类药物使用、政府保险和失业相关。膝关节手术后2年，阿片类药物再填充和更大的再填充TME与大多数患者报告的结局指标的术后评分更差相关。然而，再填充阿片类药物和更大的再填充TME与术后改善无显著相关性。控制潜在混杂变量的多变量分析证实，术后再填充TME越大，独立预测2年PROMIS身体功能、2年PROMIS疼痛干扰和2年IKDC膝关节功能评分越差。术后阿片类药物再灌注与2年患者报告的不良结局相关，呈剂量依赖性。这些发现加强了咨询患者关于阿片类药物使用和优化术后阿片类药物保留疼痛管理的重要性。
The purposes of this study were to identify the patient characteristics associated with refilling a postoperative opioid prescription after knee surgery and to determine whether refilling opioids is associated with 2-year patient-reported outcomes. We hypothesized that postoperative refill of opioids would be associated with worse 2-year patient-reported outcomes. We studied 192 patients undergoing knee surgery at a single urban academic institution. Patients completed multiple patient-reported outcome measures preoperatively and 2 years postoperatively, including six Patient-Reported Outcomes Measurement Information System (PROMIS) domains, the International Knee Documentation Committee (IKDC) questionnaire, numeric pain scale scores for the operative knee and the rest of the body, Marx Activity Rating Scale, as well as measures of met expectations, improvement, and satisfaction. Total morphine equivalents (TMEs) were calculated from a regional prescription monitoring program. Patients who refilled a postoperative opioid prescription were compared with those who did not, and TMEs were calculated for those who refilled (Refill TMEs). One hundred twenty-nine patients (67%) refilled at least one postoperative opioid prescription. Black race, older age, higher average body mass index (BMI), smoking, greater medical comorbidities, preoperative opioid use, lower income, government insurance, and knee arthroplasty were associated with refilling opioids. Greater Refill TMEs was associated with black or white race, older age, higher average BMI, smoking, greater medical comorbidities, preoperative opioid use, government insurance, and unemployment. Refilling opioids and greater Refill TMEs were associated with worse postoperative scores on most patient-reported outcome measures 2 years after knee surgery. However, refilling opioids and greater Refill TMEs did not have a significant association with improvement after surgery. Multivariable analysis controlling for potential confounding variables confirmed that greater postoperative Refill TMEs independently predicted worse 2-year PROMIS Physical Function, 2-year PROMIS Pain Interference, and 2-year IKDC knee function scores. Postoperative refill of opioids was associated with worse 2-year patient-reported outcomes in a dose-dependent fashion. These findings reinforce the importance of counseling patients regarding opioid use and optimizing opioid-sparing pain management postoperatively.