PROGNOSTIC FACTORS FOR INCREASED PAIN AND OPIOID CONSUMPTION FOLLOWING ARTHROSCOPIC KNEE AND SHOULDER SURGERY IN THE ACUTE POSTOPERATIVE PERIOD
Notice bibliographique
Résumé
Various opioid-sparing strategies have demonstrated promising results following knee and shoulder arthroscopy. There is limited high-quality evidence exists shedding light on risk factors associated with increased post-operative opioid consumption and inferior pain outcomes following knee and shoulder arthroscopy, hence the purpose of this analysis. Using the dataset from the Non-Opioid Prescriptions after Arthroscopic Surgery in Canada (NO PAin) trial, eight prognostic factors were chosen a priori to evaluate their effect on opioid consumption and patient-reported pain following arthroscopic knee and shoulder surgery. These included age, sex, body mass index (BMI), tobacco use, alcohol use, number of comorbidities, employment status, and operative time. The primary analysis for this study was a multivariable linear regression using the number of OMEs consumed at 2- and 6-weeks postoperatively as the dependant variable. Secondary analyses included a multivariable linear regression with VAS pain scores at 2- and 6-weeks postoperatively as the dependant variable. Analyses of variance (ANOVAs) were conducted on categorical dependant variables found to be significant predictors of the model to assess whether statistically significant differences existed across these dependant variables’ categories. All tests were two-tailed with alpha = 0.05. A total of 193 patients were included in the final analysis. Included patients were primarily male (62.5%), with a mean age of 43.0 (SD, 15.3) years and a mean BMI of 29.2. Most patients underwent knee surgery (n=143; 73.1%). The most common procedures performed was a meniscectomy (n=93; 48.2%) in the knee and biceps tenotomy (n=25; 13.0%) in the shoulder. Tobacco usage was significantly associated with higher opioid usage at 2-weeks (p < 0 .001) and 6-weeks (p=0.02) postoperatively. Previous tobacco users had a higher 2-week (p=0.002) and cumulative OME (p=0.002) consumption compared to current and non-smokers. Age, sex, BMI, alcohol use, number of comorbidities, employment status and operative time were not significantly associated with number of OMEs consumed at 2- and 6-weeks postoperatively. Patients with a higher number of comorbidities (p=0.006) and those who were employed (p=0.006) reported higher pain scores at 6-weeks. Patients in the ‘not employed/other’ category had significantly lower pain scores at 6-weeks postoperatively (p=0.046). Age, sex, BMI, tobacco use, alcohol use, operative time, number of comorbidities and employment status were not significantly associated with worse VAS scores at either 2- and 6-weeks. Tobacco use status was significantly associated with increased post-operative opioid consumption following knee and shoulder arthroscopy at 2- and 6-weeks postoperatively, with former smokers consuming the largest quantity of opioids. Increased pain was found to be significantly associated with employment status and an increasing number of comorbidities at 6-weeks postoperatively. Particularly, employed patients presented with the highest VAS pain scores while unemployed patients presented with the lowest VAS pain scores. The findings of this analysis can further aid clinicians in identifying and mitigating increased opioid utilization as well as worse pain outcomes in high-risk patient populations undergoing arthroscopic surgery.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».