术前阿片类药物使用与在全肩关节整形术后的不良事件之间的关系
Kiera A Kingston1, Charles Qin1, Mia Qin2
1Department of Orthopaedic Surgery and Rehabilitation Medicine, UChicago Medicine, Chicago, IL, USA.
Shoulder & elbow
|November 20, 2023
概括
在肩膀关节整形手术前持续使用阿片类药物会增加并发症,再入院和修复手术的风险. 这一发现强调了管理手术前阿片类药物使用的重要性,以便在全肩关节整形术 (TSA) 中获得更好的患者结果.
科学领域:
- 整形外科手术 整形外科手术
- 疼痛管理 疼痛管理
- 健康 结果 研究 研究 结果
背景情况:
- 手术前使用阿片类药物很常见,但它对肩部全关节整形术 (TSA) 后的结果的影响尚未得到充分证实.
- 有限的研究存在于术前阿片类药物消费和早期术后并发症,再入院或TSA后修订率之间的关联.
研究的目的:
- 调查手术前阿片类药物使用模式与接受TSA的患者90天后术后结果之间的关系.
- 确定持续的手术前阿片类药物使用是否是TSA后并发症,再入院和修复手术的独立风险因素.
主要方法:
- 对Pearldiver Humana Claims数据集的回顾性分析确定了接受TSA的患者.
- 患者被分为先前使用过阿片类药物,偶尔使用阿片类药物和持续使用阿片类药物.
- 包括90天并发症,再入院和修复手术在内的结果使用千平方测试,ANOVA和多变量后勤回归进行了分析,包括和不包括骨折诊断.
主要成果:
- 这项研究包括了18791名患者:之前使用过的阿片类药物为9933人,零星使用者为3016人,持续使用者为5842人.
- 持久性阿片类药物使用者与阿片类药物使用者和零星使用者相比,出现并发症 (9.1%),再入院 (12.6%) 和修订程序 (2.3%) 的比率显著更高 (p < .001).
- 多变量分析证实,持续使用阿片类药物独立与增加并发症 (OR1.4),再录取 (OR1.6) 和修订程序 (OR1.9) 的可能性有关,即使在排除骨折后.
结论:
- 持续的手术前阿片类药物使用是肩膀全关节整形手术早期不良后果的重要风险因素.
- 这些发现强调需要仔细考虑和管理手术前阿片类药物依赖的患者接受TSA,以减轻风险.
- 在TSA之前优化疼痛管理策略可能会改善患者的康复,并减少后续干预的需要.
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