在全关节整形术后确定与持续使用阿片类药物相关的因素:回顾性审查
Aurora Quaye1,2,3, John DiPalazzo4, Kristin Kostka5,6
1Department of Anesthesiology and Perioperative Medicine, Maine Medical Center, Portland, ME 04102, United States.
Pain medicine (Malden, Mass.)
|November 20, 2024
概括
总关节整形术后持续使用阿片类药物的预测因素包括吸烟,抗抑郁药的使用,以及前存在的条件,如PTSD或药物使用障碍. 识别这些风险因素可以帮助减少手术后的阿片类药物依赖.
科学领域:
- 整形外科手术 整形外科手术
- 疼痛管理 疼痛管理
- 医疗信息学 医疗信息学
背景情况:
- 在全关节整形术 (TJA) 后持续使用阿片类药物是一个重大问题.
- 在手术前确定有风险的患者对于有效的疼痛管理策略至关重要.
研究的目的:
- 在接受TJA的阿片类药物先患者中确定持续阿片类药物使用的预测因素.
- 开发一种持续使用阿片类药物的预测模型.
主要方法:
- 对接受TJA (2015-2020) 的阿片类药物先患者进行了回顾性队列研究.
- 最小绝对收缩和选择运算符 (LASSO) 逻辑回归用于预测建模.
- 使用观察医疗结果伙伴关系共同数据模型分析的电子健康记录数据.
主要成果:
- 6432名患者中有12.3%的人持续使用阿片类药物 (手术后90天至1年).
- 预测因素包括目前的吸烟 (OR 1.65),抗抑郁药的使用 (OR 1.76),PTSD (OR 2.07),物质使用障碍 (OR 1.69),背痛 (OR 1.43),痴呆症 (OR 1.65) 和BMI> 40 (OR 2.50).
- 年龄,性别和种族与持续使用阿片类药物无关.
结论:
- 一个经过验证的预测模型可以识别患有TJA后持续阿片类药物使用高风险的患者.
- 这种工具可以告知有针对性的干预措施,以减少术后阿片类药物依赖.
- 需要基于证据的策略来优化关节置换手术后的疼痛控制.
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