Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
Department of Orthopaedic Surgery, Lillebaelt Hospital, Vejle, Denmark.
BMJ Open. 2021 Mar 8;11(3):e039238. doi: 10.1136/bmjopen-2020-039238.
To examine the risk factors for new chronic opioid use in elderly patients who underwent hip fracture surgery.
Prospective population-based cohort study.
Using Danish nationwide health registries, we identified all opioid non-user patients aged ≥65 years who had undergone hip fracture surgery from 2005 to 2016 and were alive within the first year following surgery.
New chronic opioid use defined by the dispensing of at least two prescription opioids within two of the last three quarters during the first year following surgery.
We identified 37 202 opioid non-user patients who underwent hip fracture surgery. Of these, 5497 (15%) developed new chronic opioid user within 1 year of surgery. Risk factors for new chronic opioid use were Body Mass Index (BMI) of <18.5 (adjusted OR (aOR) 1.22, 95% CI 1.09 to 1.36), BMI of 25.0-29.9 (aOR 1.12, 95% CI 1.04 to 1.21) and BMI of ≥30 (aOR 1.57, 95% CI 1.40 to 1.76) with BMI 18.6-24.9 as reference, a pertrochanteric/subtrochanteric fracture (aOR 1.27, 95% CI 1.20 to 1.34) with femoral neck fracture as reference, preoperative use (vs no-use) of non-steroidal anti-inflammatory drug (aOR 1.68, 95% CI 1.55 to 1.83), selective serotonin reuptake inhibitor (aOR 1.42, 95% CI 1.32 to 1.53), antidepressants (aOR 1.36, 95% CI 1.24 to 1.49), antipsychotics (aOR 1.21, 95% CI 1.07 to 1.35), corticosteroids (aOR 1.54, 95% CI 1.35 to 1.76), statins (aOR 1.09, 95% CI 1.02 to 1.18), antibiotics (aOR 1.32, 95% CI 1.22 to 1.42), antiosteoporosis drugs (aOR 1.33, 95% CI 1.19 to 1.49) and anticoagulatives (aOR 1.24, 95% CI 1.17 to 1.32). Presence of cardiovascular comorbidities, diabetes, gastrointestinal diseases, dementia, chronic obstructive pulmonary disease or renal diseases was further identified as a risk factor.
In this large nationwide cohort study, we identified several risk factors associated with new chronic opioid use after hip fracture surgery among patients who were alive within the first year following surgery. Although not all factors are modifiable preoperative, this will allow clinicians to appropriately counsel patients preoperatively and tailor postoperative treatment.
探讨髋部骨折手术后老年患者新发慢性阿片类药物使用的风险因素。
前瞻性基于人群的队列研究。
我们使用丹麦全国健康登记处，确定了所有在 2005 年至 2016 年期间接受髋部骨折手术且术后第一年存活的年龄≥65 岁的非阿片类药物使用者患者。
新发慢性阿片类药物使用定义为在术后第一年的最后三个季度中的两个季度内至少开具两种处方阿片类药物。
我们确定了 37202 名未使用阿片类药物的患者接受了髋部骨折手术。其中，5497 名（15%）在手术后 1 年内成为新发慢性阿片类药物使用者。新发慢性阿片类药物使用的风险因素包括体重指数（BMI）<18.5（调整后的比值比[aOR]，1.22；95%置信区间[CI]，1.09 至 1.36）、BMI 为 25.0-29.9（aOR，1.12；95%CI，1.04 至 1.21）和 BMI≥30（aOR，1.57；95%CI，1.40 至 1.76），BMI 为 18.6-24.9 为参照，转子间/转子下骨折（aOR，1.27；95%CI，1.20 至 1.34）与股骨颈骨折相比，术前使用（与未使用相比）非甾体抗炎药（aOR，1.68；95%CI，1.55 至 1.83）、选择性 5-羟色胺再摄取抑制剂（aOR，1.42；95%CI，1.32 至 1.53）、抗抑郁药（aOR，1.36；95%CI，1.24 至 1.49）、抗精神病药（aOR，1.21；95%CI，1.07 至 1.35）、皮质类固醇（aOR，1.54；95%CI，1.35 至 1.76）、他汀类药物（aOR，1.09；95%CI，1.02 至 1.18）、抗生素（aOR，1.32；95%CI，1.22 至 1.42）、抗骨质疏松药物（aOR，1.33；95%CI，1.19 至 1.49）和抗凝剂（aOR，1.24；95%CI，1.17 至 1.32）。还确定了存在心血管合并症、糖尿病、胃肠道疾病、痴呆、慢性阻塞性肺疾病或肾脏疾病是另一个风险因素。
在这项大型全国性队列研究中，我们确定了一些与髋部骨折手术后新发慢性阿片类药物使用相关的风险因素，这些患者在术后第一年仍存活。尽管并非所有因素都是术前可改变的，但这将使临床医生能够在术前适当地为患者提供咨询，并制定术后治疗方案。
