Abstract：
BACKGROUND: Total knee and hip arthroplasty are considered a clinically and cost-effective intervention, however, persistent pain post-surgery can occur, and some continue to take opioid medications long-term. One factor which has infrequently been included in prediction modelling is rehabilitation pathway, in particular, one which includes inpatient rehabilitation. As discharge to inpatient rehabilitation post-arthroplasty is common practice, we aimed to identify whether rehabilitation pathway (discharge to in-patient rehabilitation or not) predicts continued use of opioids at 3 months (90 days) post- total knee arthroplasty (TKA) and total hip arthroplasty (THA) whilst controlling for other covariates.
METHODS: The study was nested within a prospective observational study capturing pre-operative, acute care and longer-term data from 1900 osteoarthritis (OA) patients who underwent primary TKA or THA. The larger study involved a part-random, part-convenience sample of 19 high-volume hospitals across Australia. Records with complete pre-and post-operative analgesic (35 days and 90 days) use were identified [1771 records (93% of sample)] and included in logistic regression analyses.
RESULTS: Three hundred and thirteen people (17.8%) reported ongoing opioid use at 90 days post-operatively. In the adjusted model, admission to inpatient rehabilitation after surgery was identified as an independent and significant predictor of opioid use at 90-days. Inpatient rehabilitation was associated with almost twice the odds of persistent opioid use at 90-days compared to discharge directly home (OR = 1.9 (1.4, 2.5), p < .001).
CONCLUSIONS: The inpatient rehabilitation pathway is a strong predictor of longer-term opioid use (90 days) post-arthroplasty, accounting for many known and possible confounders of use including sex, age, insurance status, major complications, smoking status and baseline body pain levels.
BACKGROUND: The study was nested within a prospective cohort observational study capturing pre-operative, acute-care and longer-term data from patients undergoing primary TKA or THA for osteoarthritis (ClinicalTrials.gov NCT01899443).
METHODS: The study was nested within a prospective observational study capturing pre-operative, acute care and longer-term data from 1900 osteoarthritis (OA) patients who underwent primary TKA or THA. The larger study involved a part-random, part-convenience sample of 19 high-volume hospitals across Australia. Records with complete pre-and post-operative analgesic (35 days and 90 days) use were identified [1771 records (93% of sample)] and included in logistic regression analyses.
RESULTS: Three hundred and thirteen people (17.8%) reported ongoing opioid use at 90 days post-operatively. In the adjusted model, admission to inpatient rehabilitation after surgery was identified as an independent and significant predictor of opioid use at 90-days. Inpatient rehabilitation was associated with almost twice the odds of persistent opioid use at 90-days compared to discharge directly home (OR = 1.9 (1.4, 2.5), p < .001).
CONCLUSIONS: The inpatient rehabilitation pathway is a strong predictor of longer-term opioid use (90 days) post-arthroplasty, accounting for many known and possible confounders of use including sex, age, insurance status, major complications, smoking status and baseline body pain levels.
BACKGROUND: The study was nested within a prospective cohort observational study capturing pre-operative, acute-care and longer-term data from patients undergoing primary TKA or THA for osteoarthritis (ClinicalTrials.gov NCT01899443).
摘要：
背景：全膝关节和髋关节置换术被认为是临床上具有成本效益的干预措施，然而,手术后可能出现持续性疼痛，有些人继续长期服用阿片类药物。预测模型中很少包含的一个因素是康复途径，特别是,其中包括住院康复。由于关节置换术后住院康复是常见的做法，我们的目的是确定康复途径(出院至住院康复)是否能预测全膝关节置换术(TKA)和全髋关节置换术(THA)后3个月(90天)继续使用阿片类药物,同时控制其他协变量.
方法：该研究嵌套在一项前瞻性观察研究中，来自1900名接受原发性TKA或THA的骨关节炎（OA）患者的急性护理和长期数据。更大的研究涉及部分随机，澳大利亚19家高容量医院的部分便利样本。确定了完整的术前和术后镇痛（35天和90天）使用记录[1771条记录（样本的93％）]并包括在逻辑回归分析中。
结果：三百十三人（17.8%）报告在术后90天持续使用阿片类药物。在调整后的模型中，手术后住院康复被认为是90天阿片类药物使用的独立且重要的预测因素.住院康复与90天持续使用阿片类药物的几率几乎是直接出院回家的两倍（OR=1.9（1.4，2.5），p<.001)。
结论：住院康复途径是关节置换术后长期使用阿片类药物（90天）的重要预测因素，考虑到许多已知和可能的使用混杂因素，包括性别，年龄,保险状况,主要并发症,吸烟状况和基线身体疼痛水平。
背景：该研究嵌套在一项前瞻性队列观察研究中，接受原发性TKA或THA治疗骨关节炎患者的急性护理和长期数据(ClinicalTrials.govNCT01899443)。
方法：该研究嵌套在一项前瞻性观察研究中，来自1900名接受原发性TKA或THA的骨关节炎（OA）患者的急性护理和长期数据。更大的研究涉及部分随机，澳大利亚19家高容量医院的部分便利样本。确定了完整的术前和术后镇痛（35天和90天）使用记录[1771条记录（样本的93％）]并包括在逻辑回归分析中。
结果：三百十三人（17.8%）报告在术后90天持续使用阿片类药物。在调整后的模型中，手术后住院康复被认为是90天阿片类药物使用的独立且重要的预测因素.住院康复与90天持续使用阿片类药物的几率几乎是直接出院回家的两倍（OR=1.9（1.4，2.5），p<.001)。
结论：住院康复途径是关节置换术后长期使用阿片类药物（90天）的重要预测因素，考虑到许多已知和可能的使用混杂因素，包括性别，年龄,保险状况,主要并发症,吸烟状况和基线身体疼痛水平。
背景：该研究嵌套在一项前瞻性队列观察研究中，接受原发性TKA或THA治疗骨关节炎患者的急性护理和长期数据(ClinicalTrials.govNCT01899443)。
