目的:来自美国的一些研究报告了肩关节置换后长期使用阿片类药物的风险增加。我们的目的是确定在丹麦全国人群中选择性肩关节置换后长期使用阿片类药物的发生率和危险因素。
方法:对2004年至2020年向丹麦肩关节成形术注册(DSR)报告的所有主要选择性肩关节置换术进行了筛选。从DSR和丹麦国家患者登记处检索有关潜在危险因素的数据,而从丹麦国家卫生服务处方数据库检索有关药物的数据。长期使用阿片类药物被定义为在手术日期(Q1)和手术后90天(Q1)的1个或多个分配处方,随后在手术后91-180天(Q2)的1个或多个分配处方。术前阿片类药物使用定义为手术前90天1种或更多的处方。Logistic回归模型用于估计长期使用阿片类药物的危险因素。
结果:我们纳入了5,660例患者。术后1,584名(28%)患者在Q1和Q2中分配了1种或更多处方,并被归类为长期阿片类药物使用者。在2,037名术前阿片类药物使用者和3,623名非阿片类药物使用者中,1,201(59%)和383(11%)分别被归类为长期用户。术前使用阿片类药物,女性性别,酗酒,以前的手术,高Charlson合并症指数,术前使用抗抑郁药,抗精神病药,或苯二氮卓类药物与长期使用阿片类药物的风险增加相关.
结论:长期使用阿片类药物的发生率为28%。术前使用阿片类药物是长期使用阿片类药物的最大危险因素,但其他几个危险因素被确定为长期使用阿片类药物.
OBJECTIVE: Several studies from the United States report an increased risk of prolonged opioid use after shoulder replacement. We aimed to determine the incidence and risk factors of prolonged opioid use after elective shoulder replacement in a nationwide Danish population.
METHODS: All primary elective shoulder arthroplasties reported to the Danish Shoulder Arthroplasty Registry (DSR) from 2004 to 2020 were screened for eligibility. Data on potential risk factors was retrieved from the DSR and the National Danish Patient Registry while data on medication was retrieved from the Danish National Health Service Prescription Database. Prolonged opioid use was defined as 1 or more dispensed prescriptions on and 90 days after date of surgery (Q1) and subsequently 1 or more dispensed prescriptions 91-180 days after surgery (Q2). Preoperative opioid use was defined as 1 or more dispensed prescriptions 90 days before surgery. Logistic regression models were used to estimate risk factors for prolonged opioid use.
RESULTS: We included 5,660 patients. Postoperatively 1,584 (28%) patients were dispensed 1 or more prescriptions in Q1 and Q2 and were classified as prolonged opioid users. Among the 2,037 preoperative opioid users and the 3,623 non-opioid users, 1,201 (59%) and 383 (11%) respectively were classified as prolonged users. Preoperative opioid use, female sex, alcohol abuse, previous surgery, high Charlson Comorbidity index, and preoperative use of either antidepressants, antipsychotics, or benzodiazepines were associated with increased risk of prolonged opioid use.
CONCLUSIONS: The incidence of prolonged opioid use was 28%. Preoperative use of opioids was the strongest risk factor for prolonged opioid use, but several other risk factors were identified for prolonged opioid use.