Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark.
Department of Clinical Medicine, Danish Center for Clinical Health Services Research (DACS), Aalborg University and Aalborg University Hospital, Aalborg, Denmark.
Eur J Pain. 2019 Aug;23(7):1309-1317. doi: 10.1002/ejp.1392. Epub 2019 Mar 25.
There is currently a knowledge gap regarding persistent opioid use after hip fracture surgery. Thus, opioid use within a year after hip fracture surgery in patients with/without opioid use before surgery was examined.
This population-based cohort study included all patients (aged ≥ 65) undergoing primary hip fracture surgery in Denmark (2005-2015) identified from the Danish Multidisciplinary Hip Fracture Database. Opioid use was assessed from The Danish National Health Service Prescription Database as redeemed prescriptions. The proportion of patients with ≥1 opioid prescription was computed within 6 months before surgery and each of four 3-month periods (quarters) after surgery, among patients alive first day in each period. Proportion differences (95% CI) were calculated for each quarter compared to before surgery. Proportions were calculated for users and nonusers before surgery, including initiators after first quarter.
This study included 69,456 patients. Proportion differences of opioid users were 35.0 (95% CI 34.5-35.5), 7.0 (95% CI 6.5-7.5), 2.9 (95% CI 2.4-3.4) and 1.4 percentage-points (95% CI 0.9-1.9) the four quarters after surgery compared to before. Among opioid nonusers before surgery, 54.7% (95% CI 54.3-55.1), 21.8% (95% CI 21.4-22.2), 17.8% (95% CI 17.4-18.2) and 16.8% (95% CI 16.4-17.2) were opioid users in 1st-4th quarter after surgery. However, 8.5% (95% CI 8.2-8.7) of the nonusers before surgery in 4th quarter initiated opioid use more than a quarter after surgery.
The proportion of opioid users increased after hip fracture surgery and was 1.4 percentage-points increased in fourth quarter compared to before. Of opioid nonusers before surgery, 16.8% were opioid users fourth quarter after surgery.
Opioid use 1 year after hip fracture surgery is common, both in patients who were opioid users and nonusers before the surgery. These significant findings point out the need for indication of benefits and risks of opioid use in the acute and long-term management of patients undergoing hip fracture surgery.
目前，髋部骨折手术后持续使用阿片类药物的知识缺口仍然存在。因此，本研究旨在评估髋部骨折手术后一年内有/无术前阿片类药物使用史的患者的阿片类药物使用情况。
本研究为基于人群的队列研究，纳入了丹麦所有（年龄≥65 岁）接受初次髋部骨折手术的患者（2005-2015 年），这些患者的信息均来自丹麦多学科髋部骨折数据库。阿片类药物的使用情况通过丹麦国家卫生服务处方数据库（以已开具处方为准）进行评估。首先计算每个时期（季度）存活至第一天的患者在术前 6 个月内以及术后每 3 个月（4 个季度）内的至少开具 1 份阿片类药物处方的患者比例。然后与术前进行比例差异（95%CI）计算。此外，还计算了术前阿片类药物使用者和非使用者的比例，包括术后第 1 季度开始使用的患者。
本研究共纳入了 69456 例患者。与术前相比，术后第 1 季度至第 4 季度的阿片类药物使用者比例分别增加了 35.0（95%CI 34.5-35.5）、7.0（95%CI 6.5-7.5）、2.9（95%CI 2.4-3.4）和 1.4 个百分点（95%CI 0.9-1.9）。术前阿片类药物非使用者中，分别有 54.7%（95%CI 54.3-55.1）、21.8%（95%CI 21.4-22.2）、17.8%（95%CI 17.4-18.2）和 16.8%（95%CI 16.4-17.2）在术后第 1 季度至第 4 季度成为阿片类药物使用者。然而，术前阿片类药物非使用者中有 8.5%（95%CI 8.2-8.7）在术后第 4 季度开始使用阿片类药物，时间超过 1 个季度。
髋部骨折手术后阿片类药物使用者的比例增加，与术前相比，第 4 季度增加了 1.4 个百分点。术前阿片类药物非使用者中，有 16.8%在术后第 4 季度成为阿片类药物使用者。
髋部骨折手术后 1 年内阿片类药物的使用较为常见，在有/无术前阿片类药物使用史的患者中均存在。这些重要发现表明，在接受髋部骨折手术的患者的急性和长期管理中，需要明确阿片类药物使用的获益和风险。
