PDF(Pubmed)
Abstract：
UNASSIGNED: Opioid overprescribing has caused a substantial increase in opioid related deaths and billions of dollars in additional healthcare costs. Orthopaedic surgeons commonly prescribe opioids in the perioperative period; however, research has shown preoperative opioid use may be associated with worse postoperative outcomes. Despite this body of evidence, there are few studies investigating the association between preoperative opioid use and two-year outcomes after hand surgery.
UNASSIGNED: This study evaluated two-year postoperative patient-reported outcomes in patients who used opioids prior to hand surgery, and those who did not. Patients completed pre and postoperative questionnaires including Patient-Reported Outcomes Measurement Information System (PROMIS) domains, the Brief Michigan Hand Questionnaire (BMHQ), and other questionnaires related to pain, function, and satisfaction. 342 patients undergoing upper-extremity surgery were enrolled into a prospective orthopaedic surgery outcome registry, and 69.9% completed the follow-up surveys. Preoperative opioid use and its association to patient outcome scores was analyzed through bivariate analysis. Significant associations were further tested by multivariable analysis to determine independent predictors.
UNASSIGNED: Preoperative opioid use was associated with worse two-year PROMIS Fatigue (p < .01), PROMIS Anxiety (p < .01), PROMIS Depression (p < .01), SSQ-8 (p = .01), BMHQ (p = .01), NPS Hand (p < .01) and MODEMS met expectations (p = .03). No significant differences were observed in patient-reported outcome change scores. Multivariable analysis demonstrated that preoperative opioid use was predictive of worse two-year PROMIS Fatigue (p < .01), PROMIS Anxiety (p < .01), PROMIS Depression (p = .02), BMHQ (p = .01), SSQ-8 (p < .01), NPS Hand (p = .02) and MODEMS met expectations (p < .01).
UNASSIGNED: Preoperative opioid use was associated with worse patient-reported outcomes two years after elective hand surgery. There was no significant difference in the improvement from baseline between the two groups. Clinically significant differences were observed in follow-up PROMIS Anxiety, BMHQ and NPS - Hand scores. Clinically significant change scores were noted in both groups for PROMIS PF, PROMIS PI, PROMIS SS, BMHQ, and NPS - Hand.
UNASSIGNED: This study evaluated two-year postoperative patient-reported outcomes in patients who used opioids prior to hand surgery, and those who did not. Patients completed pre and postoperative questionnaires including Patient-Reported Outcomes Measurement Information System (PROMIS) domains, the Brief Michigan Hand Questionnaire (BMHQ), and other questionnaires related to pain, function, and satisfaction. 342 patients undergoing upper-extremity surgery were enrolled into a prospective orthopaedic surgery outcome registry, and 69.9% completed the follow-up surveys. Preoperative opioid use and its association to patient outcome scores was analyzed through bivariate analysis. Significant associations were further tested by multivariable analysis to determine independent predictors.
UNASSIGNED: Preoperative opioid use was associated with worse two-year PROMIS Fatigue (p < .01), PROMIS Anxiety (p < .01), PROMIS Depression (p < .01), SSQ-8 (p = .01), BMHQ (p = .01), NPS Hand (p < .01) and MODEMS met expectations (p = .03). No significant differences were observed in patient-reported outcome change scores. Multivariable analysis demonstrated that preoperative opioid use was predictive of worse two-year PROMIS Fatigue (p < .01), PROMIS Anxiety (p < .01), PROMIS Depression (p = .02), BMHQ (p = .01), SSQ-8 (p < .01), NPS Hand (p = .02) and MODEMS met expectations (p < .01).
UNASSIGNED: Preoperative opioid use was associated with worse patient-reported outcomes two years after elective hand surgery. There was no significant difference in the improvement from baseline between the two groups. Clinically significant differences were observed in follow-up PROMIS Anxiety, BMHQ and NPS - Hand scores. Clinically significant change scores were noted in both groups for PROMIS PF, PROMIS PI, PROMIS SS, BMHQ, and NPS - Hand.
摘要：
■阿片类药物的过度处方导致阿片类药物相关死亡人数大幅增加，额外医疗费用数十亿美元。骨科医生通常在围手术期开出阿片类药物；然而，研究表明,术前使用阿片类药物可能与更差的术后结局相关.尽管有这么多证据,很少有研究调查术前使用阿片类药物与手手术后2年结局之间的关系.
这项研究评估了在手手术前使用阿片类药物的患者术后两年的患者报告结果，和那些没有的人。患者完成了术前和术后问卷调查，包括患者报告结果测量信息系统（PROMIS）领域，简短的密歇根手问卷(BMHQ)，和其他与疼痛有关的问卷，函数,和满意度。342名接受上肢手术的患者被纳入前瞻性骨科手术结果登记，69.9%的人完成了后续调查。通过双变量分析分析了术前阿片类药物的使用及其与患者预后评分的关联。通过多变量分析进一步检验显著关联以确定独立预测因子。
■术前使用阿片类药物与两年的PROMIS疲劳有关（p<0.01）。PROMIS焦虑（p<0.01），PROMIS抑郁（p<0.01），SSQ-8（p=0.01），BMHQ（p=0.01），NPS手（p<0.01）和模型符合预期（p=0.03）。在患者报告的结果变化评分中没有观察到显著差异。多变量分析表明，术前使用阿片类药物可预测更差的两年PROMIS疲劳(p<0.01)，PROMIS焦虑（p<0.01），PROMIS抑郁（p=0.02），BMHQ（p=0.01），SSQ-8（p<0.01），NPS手（p=0.02）和模型符合预期（p<0.01）。
■术前使用阿片类药物与择期手手术两年后患者报告的预后较差相关。两组之间相对于基线的改善没有显着差异。在随访PROMIS焦虑中观察到临床显着差异，BMHQ和NPS-手得分。两组的PROMISPF均有临床显着变化评分，PROMISPI,PROMISSS,BMHQ,和NPS-手。
这项研究评估了在手手术前使用阿片类药物的患者术后两年的患者报告结果，和那些没有的人。患者完成了术前和术后问卷调查，包括患者报告结果测量信息系统（PROMIS）领域，简短的密歇根手问卷(BMHQ)，和其他与疼痛有关的问卷，函数,和满意度。342名接受上肢手术的患者被纳入前瞻性骨科手术结果登记，69.9%的人完成了后续调查。通过双变量分析分析了术前阿片类药物的使用及其与患者预后评分的关联。通过多变量分析进一步检验显著关联以确定独立预测因子。
■术前使用阿片类药物与两年的PROMIS疲劳有关（p<0.01）。PROMIS焦虑（p<0.01），PROMIS抑郁（p<0.01），SSQ-8（p=0.01），BMHQ（p=0.01），NPS手（p<0.01）和模型符合预期（p=0.03）。在患者报告的结果变化评分中没有观察到显著差异。多变量分析表明，术前使用阿片类药物可预测更差的两年PROMIS疲劳(p<0.01)，PROMIS焦虑（p<0.01），PROMIS抑郁（p=0.02），BMHQ（p=0.01），SSQ-8（p<0.01），NPS手（p=0.02）和模型符合预期（p<0.01）。
■术前使用阿片类药物与择期手手术两年后患者报告的预后较差相关。两组之间相对于基线的改善没有显着差异。在随访PROMIS焦虑中观察到临床显着差异，BMHQ和NPS-手得分。两组的PROMISPF均有临床显着变化评分，PROMISPI,PROMISSS,BMHQ,和NPS-手。
