术后早期阿片类药物剂量依赖性使用与初次 TJA 中的假体周围关节感染和其他并发症相关。

Dose-Dependent Early Postoperative Opioid Use Is Associated with Periprosthetic Joint Infection and Other Complications in Primary TJA.

机构信息

Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, California.

出版信息

J Bone Joint Surg Am. 2021 Aug 18;103(16):1531-1542. doi: 10.2106/JBJS.21.00045.

DOI:10.2106/JBJS.21.00045

PMID:34043598

Abstract

BACKGROUND

Opioids are commonly prescribed for postoperative pain following total joint arthroplasty. Despite widespread use, few studies have examined the dose-dependent effect of perioperative opioid use on postoperative complications following total hip arthroplasty (THA) and total knee arthroplasty (TKA). Therefore, we examined the dose-dependent relationship between opioid use and postoperative complications following primary THA and TKA.

METHODS

We queried the Premier Healthcare Database to identify adult patients who underwent primary elective THA or TKA from 2004 to 2014, and quantified opioid consumption within the first 3 postoperative days. Opioid consumption was standardized to morphine milligram equivalents (MMEs). Patients were divided into quintiles on the basis of MME exposure: <54, 54 to 82, 83 to 116, 117 to 172, and >172 MMEs. Primary outcomes included postoperative periprosthetic joint infection, pulmonary embolism, deep venous thrombosis, and pulmonary complications. Secondary outcomes included wound infection, wound dehiscence, and readmission within 30 and 90 days postoperatively. Univariate and multivariate analyses were performed to compare differences between groups and to account for confounders.

RESULTS

A total of 1,525,985 patients were identified. The mean age was 65.7 ± 10.8 years, 598,320 patients (39.2%) were male, and 1,174,314 patients (77.0%) were Caucasian. On multiple logistic regression analysis, increasing MME exposure was associated with a dose-dependent increased risk of postoperative complications. Compared with patients receiving <54 MMEs, exposure to >172 MMEs was associated with greater odds of periprosthetic joint infection (adjusted odds ratio [aOR], 1.37; 95% confidence interval [CI], 1.33 to 1.42), deep venous thromboembolism (aOR, 1.34; 95% CI, 1.30 to 1.38), pulmonary embolism (aOR, 1.29; 95% CI, 1.25 to 1.34), and pulmonary complications (aOR, 1.06; 95% CI, 1.05 to 1.08). Exposure to >172 MMEs was associated with increased risk of wound infection (aOR, 1.37; 95% CI, 1.33 to 1.41), wound dehiscence (aOR, 1.24; 95% CI, 1.19 to 1.31), and readmission within 30 (aOR, 1.21; 95% CI, 1.20 to 1.22) and 90 days (aOR, 1.20; 95% CI, 1.19 to 1.21).

CONCLUSIONS

Increasing opioid use within the early postoperative period following THA or TKA was associated with a dose-dependent increased risk of periprosthetic joint infection and venous thromboembolic events.

LEVEL OF EVIDENCE

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

摘要

背景

阿片类药物常用于全关节置换术后的术后疼痛。尽管广泛使用，但很少有研究检查围手术期阿片类药物使用与全髋关节置换术（THA）和全膝关节置换术（TKA）后术后并发症的剂量依赖性效应。因此，我们检查了阿片类药物使用与初次 THA 和 TKA 后术后并发症的剂量依赖性关系。

方法

我们查询了 Premier Healthcare Database，以确定 2004 年至 2014 年期间接受初次择期 THA 或 TKA 的成年患者，并在术后前 3 天内量化阿片类药物的使用量。阿片类药物的使用量以吗啡毫克当量（MME）标准化。患者根据 MME 暴露情况分为五组：<54、54 至 82、83 至 116、117 至 172 和>172 MME。主要结局包括术后假体周围关节感染、肺栓塞、深静脉血栓形成和肺部并发症。次要结局包括伤口感染、伤口裂开和术后 30 天和 90 天内再入院。进行单变量和多变量分析以比较组间差异并解释混杂因素。

结果

共确定了 1525985 名患者。平均年龄为 65.7±10.8 岁，598320 名患者（39.2%）为男性，1174314 名患者（77.0%）为白种人。在多变量逻辑回归分析中，MME 暴露量的增加与术后并发症的剂量依赖性增加风险相关。与接受<54 MME 的患者相比，接受>172 MME 的患者发生假体周围关节感染的几率更高（调整后的优势比[aOR]，1.37；95%置信区间[CI]，1.33 至 1.42）、深静脉血栓形成（aOR，1.34；95% CI，1.30 至 1.38）、肺栓塞（aOR，1.29；95% CI，1.25 至 1.34）和肺部并发症（aOR，1.06；95% CI，1.05 至 1.08）。接受>172 MME 的患者发生伤口感染（aOR，1.37；95% CI，1.33 至 1.41）、伤口裂开（aOR，1.24；95% CI，1.19 至 1.31）和术后 30 天（aOR，1.21；95% CI，1.20 至 1.22）和 90 天（aOR，1.20；95% CI，1.19 至 1.21）再入院的风险增加。