Comparison of implant related complications amongst patients with opioid use disorder and non-users following total knee arthroplasty

• 作者: Ajit M Vakharia Dhanur M Damodar Karim G Sabeh Martin W Roche Rushabh M Vakharia Tsun Yee Law
• 来源期刊: 世界骨科杂志(英文版)
• 学科: 医学
• 关键词: OPIOID use Total KNEE ARTHROPLASTY MEDICARE Database Cost READMISSION rates
• 年，卷（期）: 2019,（3）
• 页码范围: 137-144
• 页数: 8页
• 分类号: R

摘要

BACKGROUND The influence of opioid use disorder on implant related complications,infection and readmission rates,and total global episode-of-care costs following primary total knee arthroplasty(TKA)is limited.AIM To examine whether opioid abuse in patients undergoing primary TKA.METHODS A retrospective analysis of the Medicare dataset,using the PearlDiver database,from 2005-2014 comparing outcomes in patients with opioid abusers(OUD)to non-opioid abusers(NOU)undergoing primary TKA was performed.Patient outcomes were analyzed including implant complications,readmission rates,and day-of-surgery and 90-d cost.Statistical analysis was performed with R(University of Auckland,New Zealand)calculating odds-ratio(OR)along with their respective 95%confidence interval(95%CI)and P-values.RESULTS The OUD group was at greater odds of having implant related complications overall(20.84%vs 11.25%;OR:2.07;95%CI:1.93-2.23;P<0.001).Revision(OR:2.07;95%CI:1.11-3.84;P<0.001),infection(OR:1.92;95%CI:1.72–2.18;P<0.001),periprosthetic fractures(OR:1.83;95%CI:1.16-4.79;P<0.001),and 90-d readmission rates(OR:1.47,95%CI:1.35-1.61,P<0.001)were also significantly increased.OUD patients also incurred in higher day-of-surgery and total global 90-d episode-of-care costs compared to NOU.CONCLUSION Patients with OUD show an increased risk of complications compared to the nonopioid users group.Appropriate recognition,pre-surgical optimization,and patient education are essential to mitigate these complications and improve patient outcome.