Prolonged Opioid Use and Associated Factors After Open Reduction and Internal Fixation of Tibial Shaft Fractures.

IF 1.1 4区 医学 Q3 ORTHOPEDICS
Orthopedics Pub Date : 2024-07-01 Epub Date: 2024-06-12 DOI:10.3928/01477447-20240605-02
Zakaria Chakrani, Carolina Stocchi, Husni Alasadi, Nicole Zubizarreta, Brocha Z Stern, Jashvant Poeran, David A Forsh
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引用次数: 0

Abstract

Background: The aim of this retrospective cohort study was to determine the rate of prolonged opioid use and identify associated risk factors after perioperative opioid exposure for tibial shaft fracture surgery.

Materials and methods: We used the MarketScan Commercial Claims and Encounters database (IBM) to identify patients 18 to 64 years old who filled a peri-operative opioid prescription after open reduction and internal fixation of a tibial shaft fracture from January 2016 to June 2020. Multivariable logistic regression identified factors (eg, demographics, comorbidities, medications) associated with prolonged opioid use (ie, filling an opioid prescription 91 to 180 days postoperatively); adjusted odds ratios (ORs) and 95% CIs were reported.

Results: The rate of prolonged opioid use was 10.5% (n=259/2475) in the full cohort and 6.1% (n=119/1958) in an opioid-naive subgroup. In the full cohort, factors significantly associated with increased odds of prolonged use included preoperative opioid use (OR, 4.76; 95% CI, 3.60-6.29; P<.001); perioperative oral morphine equivalents in the 4th (vs 1st) quartile (OR, 2.68; 95% CI, 1.75-4.09; P<.001); age (OR, 1.03; 95% CI, 1.02-1.04; P<.001); and alcohol or substance-related disorder (OR, 1.66; 95% CI, 1.15-2.40; P=.01). Patients in the Northeast and North Central (vs South) regions had decreased odds of prolonged use (OR, 0.61-0.69; P=.02-.04). When removing preoperative use, findings were similar in the opioid-naive subgroup.

Conclusion: Prolonged opioid use is not uncommon in this orthopedic trauma population, with the strongest risk factor being preoperative opioid use. Nevertheless, shared risk factors exist between the opioid-naive and opioid-tolerant subgroups that can guide clinical decision-making. [Orthopedics. 2024;47(4):e188-e196.].

胫骨骨折切开复位内固定术后长期使用阿片类药物及相关因素。
背景:这项回顾性队列研究旨在确定胫骨骨干骨折手术围手术期阿片类药物暴露后长期使用阿片类药物的比例并识别相关风险因素:我们使用MarketScan商业索赔和遭遇数据库(IBM)识别了2016年1月至2020年6月期间在胫骨轴骨折切开复位内固定术后开具阿片类药物围手术期处方的18至64岁患者。多变量逻辑回归确定了与阿片类药物长期使用(即术后91至180天内开具阿片类药物处方)相关的因素(如人口统计学、合并症、药物);报告了调整后的几率比(OR)和95% CI:结果:在整个队列中,阿片类药物的长期使用率为 10.5%(n=259/2475),在阿片类药物无效亚组中为 6.1%(n=119/1958)。在整个队列中,术前使用阿片类药物(OR,4.76;95% CI,3.60-6.29;PPPP=0.01)等因素与长期使用阿片类药物的几率增加有显著相关性。东北部和中北部(与南部相比)的患者长期使用阿片类药物的几率降低(OR,0.61-0.69;P=.02-.04)。如果剔除术前使用阿片类药物的情况,结果与未使用阿片类药物的亚组相似:结论:阿片类药物的长期使用在骨科创伤人群中并不少见,其中最主要的风险因素是术前使用阿片类药物。尽管如此,阿片类药物无效亚组和阿片类药物耐受亚组之间仍存在共同的风险因素,可为临床决策提供指导。[骨科。202x;4x(x):xx-xx]。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Orthopedics
Orthopedics 医学-整形外科
CiteScore
2.20
自引率
0.00%
发文量
160
审稿时长
3 months
期刊介绍: For over 40 years, Orthopedics, a bimonthly peer-reviewed journal, has been the preferred choice of orthopedic surgeons for clinically relevant information on all aspects of adult and pediatric orthopedic surgery and treatment. Edited by Robert D''Ambrosia, MD, Chairman of the Department of Orthopedics at the University of Colorado, Denver, and former President of the American Academy of Orthopaedic Surgeons, as well as an Editorial Board of over 100 international orthopedists, Orthopedics is the source to turn to for guidance in your practice. The journal offers access to current articles, as well as several years of archived content. Highlights also include Blue Ribbon articles published full text in print and online, as well as Tips & Techniques posted with every issue.
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