NarxCare Scores Greater Than 300 Are Associated with Adverse Outcomes After Primary THA.

摘要: BACKGROUND The association between preoperative prescription drug use (narcotics, sedatives, and stimulants) complications and/or greater healthcare utilization (length of stay, discharge disposition, readmission, emergency department visits, reoperation) after total joint arthroplasty has been established but not well quantified. NarxCare score (NCS) is a weighted scalar measure overall opioid, sedative, stimulant use. Higher scores reflect riskier drug-use patterns, which are calculated based on (1) the number prescribing providers, (2) dispensing pharmacies, (3) milligram equivalence doses, (4) coprescribed potentiating drugs, (5) overlapping days. aforementioned factors have incorporated into measures adverse events THA. In addition, utility NCS as in predicting post-THA explored. QUESTIONS/PURPOSES Is associated with 90-day reoperation, length disposition primary THA; there thresholds higher risk for those outcomes if such an exists? type active outcomes? METHODS Of 3040 unilateral THAs performed November 2018 December 2019, 92% (2787) had complete baseline information were subsequently included. cohort missing (NCS or demographic/racial determinants; 8%) similar BMI distribution slightly younger age lower Charlson Comorbidity Index (CCI). Outcomes this retrospective study longitudinally maintained institutional database included readmissions (all-cause, procedure, nonprocedure-related), reoperations, (ED) prolonged stay (> 2 days), (home nonhome). category THA was analyzed through multivariable regression analyses confirmatory propensity score-matched comparison age, gender, race, BMI, smoking status, CCI, insurance diagnosis, surgical approach, removed significant differences at baseline. A model constructed to evaluate (opioids, RESULTS After controlling potentially confounding variables like 300 399 odds all-cause readmission (odds ratio 2.0 [95% confidence interval 1.1 3.3]; p = 0.02), procedure-related (OR 3.3 CI 1.4 7.9]; 0.006), > days 2.2 1.5 3.2]; 1.003 1.002 1.005]; < 0.001), nonhome 1.001 1.003]; 0.019); large size allowed us find statistical associations, effect sizes so small that finding unlikely be clinically meaningful. similarly important found sedative ED visits 1.004]; 0.02). CONCLUSION Preoperative use, reflected by NCSs, dose-response Surgeons may initiate guide patient-centered discussion regarding possible postoperative risks patterns (sedatives, opioids, stimulants). An interdisciplinary approach can then initiated mitigate unfavorable patient NCSs. However, given its nature reflection rather than patients' current health does qualify basis denial ineligibility. LEVEL OF EVIDENCE Level III, diagnostic study.