术前精神药理学治疗与髋关节和膝关节置换术后新的慢性阿片类药物使用风险的关联:一项丹麦基于登记的队列研究,涉及73033例手术。

IF 2.5 2区 医学 Q1 ORTHOPEDICS
Simon Kornvig, Henrik Kehlet, Christoffer C Jørgensen, Anders Fink-Jensen, Poul Videbech, Alma B Pedersen, Claus Varnum
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引用次数: 0

摘要

背景和目的:阿片类药物的慢性使用是世界范围内非常关注的问题。因此,确定髋关节和膝关节置换术后新的慢性阿片类药物使用(COU)的危险因素对于制定针对性的预防策略至关重要。抑郁/焦虑可能是新的COU的危险因素。然而,在全国范围内,没有研究调查术前精神药物治疗(PPTs)的任何或亚组是否是髋关节和膝关节置换术后新发生COU的危险因素,这是本研究的目的。方法:这项基于人群的队列研究纳入了2015年至2022年丹麦髋关节/膝关节置换术登记处的40,476例原发性髋关节和32,557例原发性膝关节置换术。排除术前阿片类药物使用者。精神药物和阿片类药物的配药记录从丹麦国家处方登记处获得。采用二元回归,并根据年龄、性别和Charlson合并症指数进行调整,以95%置信区间(CI)估计新发COU的相对风险。结果:在接受精神药物治疗(PPTs)的髋关节患者中,4.6%(202/4,439)的患者发生了新的COU,而未使用PPTs的患者中,这一比例为2.2%(788/36,037),相应的调整相对风险为1.8 (CI 1.6-2.1)。在全膝关节置换术和单室膝关节置换术中,9.1%(298/ 3261)和6.4%(59/926)的患者有新的COU,而未使用PPTs的患者有4.7%(1,011/21,529)和2.9%(201/6,841),相应的调整相对危险度分别为1.8 (CI 1.6-2.1)和2.0 (CI 1.5-2.7)。PPT亚组分析结果相似。结论:使用PPTs的髋关节和膝关节置换术患者发生新的COU的风险几乎增加了两倍。这强调了对这些患者采取预防策略的必要性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Association of preoperative psychopharmacological treatment and the risk of new chronic opioid use after hip and knee arthroplasty: a Danish registry-based cohort study of 73,033 procedures.

Background and purpose:  Chronic opioid use is of great concern worldwide. Thus, identification of risk factors for new chronic opioid use (COU) after hip and knee arthroplasty is imperative to target preventive strategies. Depression/anxiety may be risk factors for new COU. However, no studies have investigated whether any or subgroups of preoperative psychopharmacological treatments (PPTs) are risk factors for new COU after hip and knee arthroplasty in a nationwide setting, which was the aim of the present study.

Methods:  This population-based cohort study included 40,476 primary hip and 32,557 primary knee arthroplasties from 2015 to 2022 using the Danish Hip/Knee Arthroplasty Registers. Preoperative opioid users were excluded. Dispensing records of psychotropics and opioids were obtained from the Danish National Prescription Registry. Relative risks of new COU were estimated with 95% confidence intervals (CI) using binary regression and adjusted for age, sex, and Charlson Comorbidity Index.

Results:  Among hip patients using psychopharmacological treatments (PPTs), 4.6% (202/4,439) had new COU compared with 2.2% (788/36,037) of patients not using PPTs, corresponding to an adjusted relative risk of 1.8 (CI 1.6-2.1). Among total and unicompartmental knee arthroplasties, 9.1% (298/3,261) and 6.4% (59/926) had new COU compared with 4.7 (1,011/21,529) and 2.9% (201/6,841) of patients not using PPTs, corresponding to adjusted relative risks of 1.8 (CI 1.6-2.1) and 2.0 (CI 1.5-2.7), respectively. Analyses of PPT subgroups showed similar results.

Conclusion:  Hip and knee arthroplasty patients using PPTs have almost a twofold increased risk of new COU. This emphasizes the need for prevention strategies in these patients.

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来源期刊
Acta Orthopaedica
Acta Orthopaedica 医学-整形外科
CiteScore
6.40
自引率
8.10%
发文量
105
审稿时长
4-8 weeks
期刊介绍: Acta Orthopaedica (previously Acta Orthopaedica Scandinavica) presents original articles of basic research interest, as well as clinical studies in the field of orthopedics and related sub disciplines. Ever since the journal was founded in 1930, by a group of Scandinavian orthopedic surgeons, the journal has been published for an international audience. Acta Orthopaedica is owned by the Nordic Orthopaedic Federation and is the official publication of this federation.
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