Department of Emergency Medicine, Research Centre, CIUSSS-Nord-de-l'Île de-Montréal, Sacré-Coeur Hospital, Montréal, Québec, Canada.
Faculté de Médecine, Université de Montréal, Montréal, Québec, Canada.
Ann Surg. 2018 Dec;268(6):985-991. doi: 10.1097/SLA.0000000000002461.
Evaluate the incidence and risk factors of opioid use 1 year after injury in elderly trauma patients.
The current epidemic of prescription opioid misuse and overdose observed in North America generally concerns young patients. Little is known on long-term opioid use among the elderly trauma population.
In a retrospective observational multicenter cohort study conducted on registry data, all patients 65 years and older admitted (hospital stay >2 days) for injury in 57 adult trauma centers in the province of Quebec (Canada) between 2004 and 2014 were included. We searched for filled opioid prescriptions in the year preceding the injury, up to 3 months and 1 year after the injury.
In all, 39,833 patients were selected for analysis. Mean age was 79.3 years (±7.7), 69% were women, and 87% of the sample was opioid-naive. After the injury, 38% of the patients filled an opioid prescription within 3 months and 10.9% [95% confidence interval (CI) 10.6%-11.2%] filled an opioid prescription 1 year after trauma: 6.8% (95% CI 6.5%-7.1%) were opioid-naïve and 37.6% (95% CI 36.3%-38.9%) were opioid non-naive patients. Controlling for confounders, patients who filled 2 or more opioid prescriptions before the injury and those who filled an opioid prescription within 3 months after the injury were, respectively, 11.4 and 3 times more likely to use opioids 1 year after the injury compared with those who did not fill opioid prescriptions.
These results highlight that elderly trauma patients are at risk of long-term opioid use, especially if they had preinjury or early postinjury opioid consumption.
评估老年创伤患者受伤后 1 年内阿片类药物使用的发生率和风险因素。
目前，北美观察到的处方类阿片类药物滥用和过量现象普遍涉及年轻患者。关于老年创伤人群长期使用阿片类药物的情况知之甚少。
在一项回顾性观察性多中心队列研究中，我们对 2004 年至 2014 年期间魁北克省（加拿大）57 家成人创伤中心收治的（住院时间＞2 天）所有 65 岁及以上的患者的登记数据进行了分析。我们搜索了受伤前一年、受伤后 3 个月和 1 年期间的阿片类药物处方。
共纳入 39833 例患者进行分析。患者的平均年龄为 79.3 岁（±7.7），69%为女性，87%的样本为阿片类药物初治者。受伤后，38%的患者在 3 个月内开具了阿片类药物处方，10.9%[95%置信区间（CI）10.6%-11.2%]的患者在创伤后 1 年开具了阿片类药物处方：6.8%（95%CI 6.5%-7.1%）的患者为阿片类药物初治者，37.6%（95%CI 36.3%-38.9%）的患者为阿片类药物非初治者。控制混杂因素后，与未开具阿片类药物处方的患者相比，受伤前开具 2 种或以上阿片类药物处方的患者以及受伤后 3 个月内开具阿片类药物处方的患者，在受伤后 1 年内使用阿片类药物的可能性分别增加 11.4 倍和 3 倍。
这些结果表明，老年创伤患者存在长期使用阿片类药物的风险，尤其是那些在受伤前或受伤后早期有阿片类药物使用史的患者。
