Factors Associated With Concurrent Benzodiazepine and Opioid Use Following Total Hip and Knee Arthroplasty: A Nationwide Cohort Study.

IF 2.4 4区医学 Q3 PHARMACOLOGY & PHARMACY

Pharmacoepidemiology and Drug Safety Pub Date : 2026-04-01 DOI:10.1002/pds.70368

Manuela Yepes-Calderón, Rob G H H Nelissen, Marcel L Bouvy, Liza N van Steenbergen, Albert Dahan, Frits R Rosendaal, Maaike G J Gademan

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引用次数: 0

Abstract

Purpose: Concurrent use of benzodiazepines and opioids is discouraged due to synergistic adverse effects. However, patients undergoing total hip or knee arthroplasty (THA/TKA) often receive them, particularly in the first 3 postoperative months. We identified factors associated with new outpatient concurrent benzodiazepine-opioid dispensation following THA/TKA.

Methods: In this nationwide cohort study, we linked the Dutch Arthroplasty Register with the Dutch Foundation for Pharmaceutical Statistics, which provided medication dispensation data. We included all patients undergoing primary elective THA/TKA (2013-2022) who had no preoperative concurrent use in the 6 months pre-procedure. The primary outcome was ≥ 7 days of a new concurrent benzodiazepine-opioid dispensation within 90-day postoperative. Determinants included patient and implant characteristics, and preoperative medication use. Multivariable logistic regression analyses were performed, adjusted for age, sex, and comorbidity.

Results: Among 89 139 THA and 76 710 TKA patients, 3756 (4%) and 5571 (7%), respectively, received new postoperative concurrent benzodiazepine-opioid dispensation within 90-days postoperative. The main factor associated with such dispensation was preoperative benzodiazepine use (THA: OR 23.5 [95% CI: 21.8-25.3], TKA: OR 22.8 [95% CI: 21.3-24.3]), followed by preoperative antidepressant/anxiolytic use (THA: OR 2.9 [95% CI: 2.6-3.1], TKA: OR 2.5 [95% CI: 2.3-2.7]). Other factors included female sex, current smoking, and American Society of Anesthesiologists (ASA) scale III-IV. Preoperative pain scores, preoperative opioid use, and implant characteristics showed little to no association with the outcome.

Conclusions: Preoperative benzodiazepine use was the main factor associated with new outpatient concurrent benzodiazepine-opioid dispensation after THA/TKA, followed by preoperative antidepressant/anxiolytic use. These results highlighted that careful review of the patient's medication history when planning postoperative pain management could help prevent unsafe co-prescription.

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全髋关节和膝关节置换术后苯二氮卓类药物和阿片类药物同时使用的相关因素：一项全国性队列研究。

目的：不鼓励同时使用苯二氮卓类药物和阿片类药物，因为它们会产生协同不良反应。然而，接受全髋关节或膝关节置换术（THA/TKA）的患者通常会接受它们，特别是在术后的前3个月。我们确定了与THA/TKA后新门诊并发苯二氮卓类阿片类药物配药相关的因素。方法：在这项全国性队列研究中，我们将荷兰关节成形术登记与荷兰药物统计基金会联系起来，后者提供了药物分配数据。我们纳入了所有接受初级选择性THA/TKA（2013-2022）且术前6个月内未同时使用的患者。主要终点是术后90天内同时服用苯二氮卓类阿片类药物≥7天。决定因素包括患者和植入物的特征，以及术前用药。进行多变量logistic回归分析，调整年龄、性别和合并症。结果：89 139例THA和76 710例TKA患者中，分别有3756例（4%）和5571例（7%）患者在术后90天内接受了新的术后并发苯二氮卓类阿片类药物配药。与这种分配相关的主要因素是术前使用苯二氮卓类药物（THA: OR 23.5 [95% CI: 21.8-25.3], TKA: OR 22.8 [95% CI: 21.3-24.3]），其次是术前使用抗抑郁药/抗焦虑药（THA: OR 2.9 [95% CI: 2.6-3.1], TKA: OR 2.5 [95% CI: 2.3-2.7]）。其他因素包括女性性别、当前吸烟和美国麻醉医师协会（ASA） III-IV级。术前疼痛评分、术前阿片类药物使用和植入物特征与结果几乎没有关联。结论：术前苯二氮卓类药物使用是THA/TKA术后门诊同时使用苯二氮卓类药物的主要因素，其次是术前使用抗抑郁药/抗焦虑药。这些结果强调，在计划术后疼痛管理时仔细审查患者的用药史有助于防止不安全的联合处方。

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

Pharmacoepidemiology and Drug Safety 医学-药学

CiteScore

4.80

自引率

7.70%

发文量

173

审稿时长

3 months

期刊介绍： The aim of Pharmacoepidemiology and Drug Safety is to provide an international forum for the communication and evaluation of data, methods and opinion in the discipline of pharmacoepidemiology. The Journal publishes peer-reviewed reports of original research, invited reviews and a variety of guest editorials and commentaries embracing scientific, medical, statistical, legal and economic aspects of pharmacoepidemiology and post-marketing surveillance of drug safety. Appropriate material in these categories may also be considered for publication as a Brief Report. Particular areas of interest include: design, analysis, results, and interpretation of studies looking at the benefit or safety of specific pharmaceuticals, biologics, or medical devices, including studies in pharmacovigilance, postmarketing surveillance, pharmacoeconomics, patient safety, molecular pharmacoepidemiology, or any other study within the broad field of pharmacoepidemiology; comparative effectiveness research relating to pharmaceuticals, biologics, and medical devices. Comparative effectiveness research is the generation and synthesis of evidence that compares the benefits and harms of alternative methods to prevent, diagnose, treat, and monitor a clinical condition, as these methods are truly used in the real world; methodologic contributions of relevance to pharmacoepidemiology, whether original contributions, reviews of existing methods, or tutorials for how to apply the methods of pharmacoepidemiology; assessments of harm versus benefit in drug therapy; patterns of drug utilization; relationships between pharmacoepidemiology and the formulation and interpretation of regulatory guidelines; evaluations of risk management plans and programmes relating to pharmaceuticals, biologics and medical devices.