长期使用阿片类药物的社会决定因素 在膝盖关节整形术后
Katherine Hadlandsmyth1,2, Brian C Lund1,3, Yubo Gao1,4
1Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Medical Center, Iowa City, Iowa.
The journal of knee surgery
|April 10, 2024
概括
健康的社会决定因素,如住房不稳定可能会增加长期阿片类药物使用 (LTO) 后全膝关节整形术 (TKA). 然而,在这项老兵研究中,手术前阿片类药物供应是LTO最强的预测因素.
科学领域:
- 整形外科手术 整形外科手术
- 疼痛管理 疼痛管理
- 医疗保健服务研究 医疗服务研究
背景情况:
- 膝关节整形术 (TKA) 可以导致持续的疼痛和长期的阿片类药物使用 (LTO).
- 健康的社会决定因素 (SDoH) 对LTO后TKA的影响尚未得到充分理解.
- 识别与LTO相关的SDoH对于改善患者的治疗结果至关重要.
研究的目的:
- 在老老兵中研究TKA后SDoH和LTO之间的关联.
- 测试SDoH预测LTO的假设,控制人口统计和临床因素.
- 确定可能对LTO构成风险的特定SDoH.
主要方法:
- 使用退伍军人事务和医疗保险的数据进行了回顾性队列研究.
- 包括65岁或以上的退伍军人接受了选择性TKA (2013-2019) 没有并发症或之前显著的阿片类药物使用.
- 定义的LTO是术后90天内使用阿片类药物超过90天;评估的SDoH包括地区贫困指数,农村和住房不稳定.
主要成果:
- 在9064名退伍军人中,3.7%的人患上了LTO.
- 最初,住房不稳定和农村地区在未经调整的模型中显示出与LTO有显著的关联.
- 在对共变量进行调整后,只有手术前的阿片类药物供应 (几天和初始填充) 仍然与LTO有显著的关联.
结论:
- 在多变量调整后,SDoH预测TKA后的LTO的主要假设没有得到支持.
- 住房不稳定可能表明患者面临着独特的术后疼痛管理挑战和潜在的更高的LTO风险.
- 手术前的阿片类药物使用模式是全膝关节整形术后LTO的强有力的预测因素.
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