Association between bariatric surgery with long-term analgesic prescription and all-cause mortality among patients with osteoarthritis: a general population-based cohort study,Osteoarthritis and Cartilage

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Association between bariatric surgery with long-term analgesic prescription and all-cause mortality among patients with osteoarthritis: a general population-based cohort study
Osteoarthritis and Cartilage ( IF 7 ) Pub Date : 2021-07-19 , DOI: 10.1016/j.joca.2021.05.063
C Zeng ₁ , N E Lane ₂ , X Li ₃ , J Wei ₄ , H Lyu ₅ , M Shao ₆ , G Lei ₇ , Y Zhang ₈

Affiliation

Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China.
Division of Rheumatology, Allergy and Clinical Immunology, Department of Medicine, University of California, Davis, CA, USA.
Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, China.
Health Management Center, Xiangya Hospital, Central South University, Changsha, China.
Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China; Department of Orthopedics, General Hospital of Chinese PLA, Beijing, China.
Department of Gastrointestinal Surgery, Xiangya Hospital, Central South University, Changsha, China.
Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China; Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.
Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA; The Mongan Institute, Massachusetts General Hospital, Harvard Medical School, Boston, USA.

Objectives

There is still a large unmet need for novel osteoarthritis (OA) treatments that could provide clinically important effects on long-term pain relief (≥12 months). We examined the relation of bariatric surgery along with weight loss to analgesic prescription and all-cause mortality among individuals with OA.

Methods

We conducted a cohort study among individuals with OA using The Health Improvement Network. We compared the rate of no analgesic prescription ≥12 consecutive months and the risk of all-cause mortality using inverse probability weighting Cox-proportional hazard models and the difference in number of analgesic prescriptions (non-steroidal anti-inflammatory drugs, opioids, and paracetamol) in the 50^th, 75^th and 90^th percentiles using quantile regression model between bariatric and non-bariatric cohorts.

Results

Included were 588,494 individuals (694 had bariatric surgery). Compared with non-bariatric group, the rate of no analgesic prescription ≥12 consecutive months was higher (HR = 1.23, 95% CI: 1.08–1.38) in bariatric surgery group, and the number of analgesic prescriptions was lower in the 75^th (44 vs 58) and 90^th (74 vs 106) percentiles during a mean follow-up of 4.3 years. All-cause mortality in bariatric surgery group was lower than comparison group (HR = 0.46, 95% CI: 0.41–0.51).

Conclusion

This study presents the first evidence that bariatric surgery was associated with decreased long-term analgesic prescription and decreased all-cause mortality among individuals with OA. However, our findings may be overestimated owing to intractable confounding by indication for bariatric surgery; thus, future studies (e.g., clinical trials) are warranted.

中文翻译：

减肥手术与长期镇痛药处方与骨关节炎患者全因死亡率之间的关系：一项基于一般人群的队列研究

目标

对新型骨关节炎 (OA) 治疗仍有很大的未满足需求，这些治疗可以对长期疼痛缓解（≥12 个月）提供临床上重要的效果。我们研究了 OA 患者减肥手术和体重减轻与镇痛处方和全因死亡率的关系。

方法

我们使用健康改善网络对 OA 患者进行了一项队列研究。我们使用逆概率加权 Cox 比例风险模型和镇痛剂处方数量的差异（非甾体抗炎药、阿片类药物和扑热息痛) 在第 50 、^第75和^第90^百分位数中使用肥胖和非肥胖人群之间的分位数回归模型。

结果

包括 588,494 人（694 人进行了减肥手术）。与非减肥组相比，减肥手术组连续≥12个月无止痛处方率较高（HR=1.23，95%CI：1.08~1.38），75^日镇痛处方数较低（在 4.3 年的平均随访期间，44 对 58) 和 90^{个百分位数 (74 对 106)。}减肥手术组的全因死亡率低于对照组（HR = 0.46，95% CI：0.41-0.51）。