PDF(Pubmed)
Abstract：
UNASSIGNED: Ehlers-Danlos syndrome (EDS), a disorder affecting synthesis of collagen, typically presents with chronic pain, hypermobility, and early osteoarthritis. EDS patients undergoing total hip arthroplasty (THA) are at risk of dislocation and revision. Opioid use and impact on outcomes among this population remain unknown.
UNASSIGNED: A retrospective review was performed with a large national database querying the International Classification of Disease, tenth revision procedure codes identifying 1,244,368 primary THAs from 2015-2020. Two hundred thirty-eight EDS patients underwent THA and were propensity matched with population control based on age, sex, and obesity when comparing opioid prescription. To compare dislocation and revision outcomes, EDS patients were stratified into those receiving opioid prescriptions and those not. Multivariate analysis evaluated the association.
UNASSIGNED: EDS patients were more likely prescribed opioids 90 days before (49.1% vs 34.7.0%, P < .0001) and after THA (59.7% vs 41.2%, P < .0001), with more preoperatively (1163.6 mme ±1562.8, P < .0001) and postoperatively (900.1 mme ±1235.9, P < .0001) than controls. In EDS patients prescribed opioids 90 days before THA, dislocation rate was 12.8% vs 7.1% not prescribed (odds ratio 2.08, 95% confidence interval 0.85-5.1). 14.8% of EDS patients who received opioids 90 days after THA dislocated vs 2.1% not prescribed (odds ratio 8.13, 95% confidence interval 1.87-35.7).
UNASSIGNED: EDS patients are more likely prescribed opioids before and after THA. Opioid prescription was associated with risk of dislocation, though we caution interpretation of causation. However, this suggests that the risks of worse outcomes in EDS patients undergoing THA are multifactorial. We should look at strategies to reduce opioid use prior to THA.
UNASSIGNED: A retrospective review was performed with a large national database querying the International Classification of Disease, tenth revision procedure codes identifying 1,244,368 primary THAs from 2015-2020. Two hundred thirty-eight EDS patients underwent THA and were propensity matched with population control based on age, sex, and obesity when comparing opioid prescription. To compare dislocation and revision outcomes, EDS patients were stratified into those receiving opioid prescriptions and those not. Multivariate analysis evaluated the association.
UNASSIGNED: EDS patients were more likely prescribed opioids 90 days before (49.1% vs 34.7.0%, P < .0001) and after THA (59.7% vs 41.2%, P < .0001), with more preoperatively (1163.6 mme ±1562.8, P < .0001) and postoperatively (900.1 mme ±1235.9, P < .0001) than controls. In EDS patients prescribed opioids 90 days before THA, dislocation rate was 12.8% vs 7.1% not prescribed (odds ratio 2.08, 95% confidence interval 0.85-5.1). 14.8% of EDS patients who received opioids 90 days after THA dislocated vs 2.1% not prescribed (odds ratio 8.13, 95% confidence interval 1.87-35.7).
UNASSIGNED: EDS patients are more likely prescribed opioids before and after THA. Opioid prescription was associated with risk of dislocation, though we caution interpretation of causation. However, this suggests that the risks of worse outcomes in EDS patients undergoing THA are multifactorial. We should look at strategies to reduce opioid use prior to THA.
摘要：
■埃勒斯-丹洛斯综合征（EDS），影响胶原蛋白合成的疾病，通常表现为慢性疼痛，高流动性,和早期骨关节炎。接受全髋关节置换术（THA）的EDS患者存在脱位和翻修的风险。阿片类药物的使用和对该人群结果的影响仍然未知。
■使用查询国际疾病分类的大型国家数据库进行了回顾性审查，第十次修订程序代码确定了2015-2020年的1,244,368个主要THA。两百三十八例EDS患者接受了THA，并根据年龄与人口控制进行了倾向匹配，性别,和肥胖时比较阿片类药物处方。为了比较错位和修正结果，将EDS患者分为接受阿片类药物处方和未接受阿片类药物处方的患者。多变量分析评估了相关性。
■EDS患者在90天前服用阿片类药物的可能性更大（49.1%vs34.7.0%，P<.0001)和THA后(59.7%对41.2%，P<.0001),术前（1163.6mme±1562.8，P<.0001）和术后（900.1mme±1235.9，P<.0001）比对照组多。在EDS患者在THA前90天服用阿片类药物，脱位率为12.8%,未处方脱位率为7.1%(比值比2.08,95%置信区间0.85-5.1).在THA脱位后90天接受阿片类药物治疗的EDS患者中，14.8％与未处方的2.1％（比值比8.13，95％置信区间1.87-35.7）。
■EDS患者在THA前后更有可能服用阿片类药物。阿片类药物处方与脱位风险相关，尽管我们谨慎解释因果关系。然而,这表明,接受THA的EDS患者预后较差的风险是多因素的.我们应该考虑在THA之前减少阿片类药物使用的策略。
■使用查询国际疾病分类的大型国家数据库进行了回顾性审查，第十次修订程序代码确定了2015-2020年的1,244,368个主要THA。两百三十八例EDS患者接受了THA，并根据年龄与人口控制进行了倾向匹配，性别,和肥胖时比较阿片类药物处方。为了比较错位和修正结果，将EDS患者分为接受阿片类药物处方和未接受阿片类药物处方的患者。多变量分析评估了相关性。
■EDS患者在90天前服用阿片类药物的可能性更大（49.1%vs34.7.0%，P<.0001)和THA后(59.7%对41.2%，P<.0001),术前（1163.6mme±1562.8，P<.0001）和术后（900.1mme±1235.9，P<.0001）比对照组多。在EDS患者在THA前90天服用阿片类药物，脱位率为12.8%,未处方脱位率为7.1%(比值比2.08,95%置信区间0.85-5.1).在THA脱位后90天接受阿片类药物治疗的EDS患者中，14.8％与未处方的2.1％（比值比8.13，95％置信区间1.87-35.7）。
■EDS患者在THA前后更有可能服用阿片类药物。阿片类药物处方与脱位风险相关，尽管我们谨慎解释因果关系。然而,这表明,接受THA的EDS患者预后较差的风险是多因素的.我们应该考虑在THA之前减少阿片类药物使用的策略。
