Lindestrand Anna Gaki, Christiansen Marie Louise Schougaard, Jantzen Christopher, van der Mark Susanne, Andersen Stig Ejdrup
Orthopaedic Department, Bispebjerg University Hospital, Denmark.
Department of Clinical Pharmacology, Bispebjerg University Hospital, Denmark.
Injury. 2015 Jul;46(7):1341-5. doi: 10.1016/j.injury.2015.04.016. Epub 2015 Apr 18.
The aim of this study was to investigate the use of opioids among hip fracture patients, and the potential relation between perioperative prescription of opioids, mortality and chronic opioid use. The purpose of this study was to investigate the use of opioids among hip fracture patients postoperatively and 90- and 180 days after discharge. The study also analysed predictors of early death at 30-, 90 and 365 days after discharge.
We present data from the Orthopaedic Department at Bispebjerg University Hospital from 30 May 2010 and 31 March 2011 on 416 consecutively admitted hip fracture patients. Three patients died before surgery and were excluded from the analyses. Data were collected through medical records, hospital and national databases. Medication use was analysed before admission, at 3 and 6 months. Mortality data were analysed at 30 days, 6 months and 1 year.
24% were opioid users at admission, of whom 13% had an active malignant disease and 20% had been diagnosed with osteoporosis. 95% received opioids during admission, and 81% received a prescription for opioids at discharge. This fraction decreased to 36% at 3 months and 30% at 6 months. 2.9% of previous opioid naïve patients remained users at 6 months. Opioid use prior to admission and a pre-existing diagnosis of osteoporosis were the most significant factors associated with continued use at 3 and 6 months. The 30-day mortality was 10% and 1-year mortality was 27%. Mortality was associated with high age, ASA score>2, active cancer, high creatinine and leucocytosis. We found no association between opioids and mortality.
The results of our study indicate no general reason to refrain from prescribing opioids to hip fracture patients based on a fear of potential abuse or increased mortality.
本研究旨在调查髋部骨折患者阿片类药物的使用情况，以及围手术期阿片类药物处方、死亡率和慢性阿片类药物使用之间的潜在关系。本研究的目的是调查髋部骨折患者术后以及出院后90天和180天阿片类药物的使用情况。该研究还分析了出院后30天、90天和365天早期死亡的预测因素。
我们提供了2010年5月30日至2011年3月31日比斯佩布杰格大学医院骨科416例连续入院的髋部骨折患者的数据。3例患者在手术前死亡，被排除在分析之外。数据通过病历、医院和国家数据库收集。分析入院前、3个月和6个月时的用药情况。分析30天、6个月和1年时的死亡率数据。
入院时24%为阿片类药物使用者，其中13%患有活动性恶性疾病，20%被诊断为骨质疏松症。95%的患者在住院期间使用了阿片类药物，81%的患者在出院时收到了阿片类药物处方。这一比例在3个月时降至36%，在6个月时降至30%。6个月时，之前未使用过阿片类药物的患者中有2.9%仍在使用。入院前使用阿片类药物和预先诊断为骨质疏松症是与3个月和6个月持续使用相关的最显著因素。30天死亡率为10%，1年死亡率为27%。死亡率与高龄、美国麻醉医师协会（ASA）评分>2、活动性癌症、高肌酐和白细胞增多有关。我们发现阿片类药物与死亡率之间没有关联。
我们的研究结果表明，没有普遍的理由因担心潜在滥用或死亡率增加而避免给髋部骨折患者开阿片类药物。
