非烟草尼古丁依赖对关节镜下半月板部分切除术后疗效的影响
简介
基于TriNetX数据库对近2万名关节镜部分半月板切除术后患者的倾向性匹配分析，发现非烟草尼古丁依赖（电子烟、尼古丁袋等）患者术后90天内急诊就诊、门诊就诊及肺炎发生率显著升高，术后1年阿片类药物处方更多，且后续半月板手术率更高，即使在阿片类药物初治患者中亦如此。该结果表明非烟草尼古丁依赖是关节镜半月板切除术后不良结局的独立风险因素，建议术前常规进行尼古丁筛…
英文摘要
BACKGROUND: Non-tobacco nicotine dependence (NTND) from products like electronic cigarettes and pouches is rapidly rising. Smoking can negatively impact outcomes following arthroscopic partial meniscectomy (APM), but literature on NTND is sparse. The purpose of this study was to compare outcomes following APM in patients with and without NTND. MATERIALS AND METHODS: The TriNetX database was queried to identify patients older than 18 years who underwent isolated primary APM. Patients were stratified into 2 cohorts based on NTND history and underwent 1:1 propensity score matching on demographics, substance use, and comorbidities. Outcomes included (1) postoperative complications and health care use within 90 days, (2) opioid prescriptions within 1 year, and (3) subsequent knee surgery within 2 years. Subgroup analyses compared ipsilateral revision meniscus surgery rates and opioid prescriptions in opioid-naive patients. RESULTS: Within 90 days, patients with NTND (n = 9,594), compared to those without (n = 9,594), had higher rates of emergency department visits (P < .001), outpatient visits (P = .015), and pneumonia (P = .011). More patients with NTND were prescribed opioids at all time points within 1 year (P < .001), and they received more prescriptions starting at 1 month (all P ≤ .006). More opioid-naive patients with NTND were prescribed opioids starting at 1 month postoperatively (P < .05). Patients with NTND had higher rates of subsequent meniscus surgery at 1 year (P = .004) and 2 years (P < .001) but no differences in revision rates. CONCLUSION: NTND is associated with higher rates of health care use, complications, subsequent meniscus surgery, and opioid prescriptions, including among opioid-naive patients, following APM. Preoperative nicotine screening and patient education are warranted.