■全肩关节成形术(TSA)后的疼痛控制是多因素的。当前的护理标准包括使用多模式镇痛方法,包括突破性的阿片类药物处方,以提供术后镇痛。虽然这种原始的阿片类药物处方足以满足大多数患者的需求,有些人继续需要长期使用阿片类药物。我们的研究调查了手术后与阿片类药物补充相关的患者风险因素。
在TruvenMarketscan®数据库中查询了2010年至2017年接受原发性解剖TSA或原发性反向TSA的所有患者。阿片类药物数据是使用国家药物代码(NDC)从门诊药房索赔中收集的。仅包括未接受阿片类药物治疗的患者。然后根据术后阿片类药物的使用将患者分为3个队列中的1个:1)没有额外补充的患者,2)术后6个月内至少补充一次的患者,3)过去6个月有额外补充和持续使用阿片类药物的患者。
■在总共17,706名接受TSA的阿片类药物初治患者中,10882(61.5%)没有任何额外的补充,4473(25.3%)在手术后6个月内需要额外的处方,和2351(13.3%)的阿片类药物长期使用超过术后6个月.确定了初始阿片类药物处方量与再充剂和长期使用风险之间的剂量依赖性关系。长期使用组比不补充组多5mg羟考酮丸,相当于20.0,比补充组多12.7(P<.001)。在多变量分析中,年龄较小,女性性别,和烟草的使用,伴随着冠状动脉疾病的合并症,临床抑郁症,糖尿病,和风湿性疾病都被发现是长期使用阿片类药物的预测因素。
■观察到的原始阿片类药物处方数据与所需额外补充数量之间的剂量依赖性关系,这表明,最初过量使用阿片类药物可能会导致长期依赖。这项研究还确定了长期使用阿片类药物的几个独立风险因素,包括年龄较小,抑郁症,烟草使用。这项研究有望帮助识别高危患者人群,并为未来阿片类药物处方标准化和术前阿片类药物教育的研究奠定基础。
UNASSIGNED: Pain control following a total shoulder arthroplasty (TSA) is multifactorial. The current standard of care includes the utilization of a multimodal analgesic approach including breakthrough prescription opioid medication in an effort to provide postoperative analgesia. While this original opioid prescription is sufficient for the majority of patients, some go on to require prolonged opioid use. Our study investigated patient risk factors associated with opioid refill postsurgery.
UNASSIGNED: The Truven Marketscan® database was queried for all patients who underwent either a primary anatomic TSA or primary reverse TSA from 2010 to 2017. Opioid data were collected using National Drug Codes (NDC) from outpatient pharmacy claims. Only opioid-naïve patients were included. Patients were then grouped into 1 of 3 cohorts based on postoperative opioid use: 1) Patients with no additional refills, 2) patients with a minimum of one additional refill up through 6 months postoperatively, and 3) patients with additional refills and continued opioid use past 6 months.
UNASSIGNED: Of the total of 17,706 opioid-naïve patients that underwent a TSA, 10,882 (61.5%) did not have any additional refills, 4473 (25.3%) required an additional prescription within 6 months after surgery, and 2351 (13.3%) had prolonged opioid use beyond 6 months postoperatively. A dose-dependent relationship was identified between initial opioid prescription quantity and risk for refill and prolonged use. The prolonged use group was prescribed an equivalent of 20.0 more 5 mg oxycodone pills than the no refill group and 12.7 more than the refill group (P < .001). On multivariate analysis, younger age, female gender, and tobacco use, along with the comorbidities of coronary artery disease, clinical depression, diabetes, and rheumatic disease were all found to be predictive factors of prolonged opioid use.
UNASSIGNED: The dose-dependent relationship observed between original opioid prescription data and number of additional refills needed, suggests that initially overprescribing opioids may lead to prolonged dependency. This study also identified several independent risk factors for prolonged opioid use, including younger age, depression, and tobacco use. This study will hopefully help recognize high-risk patient populations and serve as the foundation for future studies into opioid prescription standardization and preoperative opioid education.