Division of Trauma and Critical Care and Acute Care Surgery, Department of Surgery, 22957Duke University Medical Center, Durham, NC, USA.
The Critical Care and Perioperative Epidemiologic Research (CAPER) Unit, 22957Duke University Medical Center, Durham, NC, USA.
Am Surg. 2022 Aug;88(8):2003-2010. doi: 10.1177/00031348211023397. Epub 2021 May 28.
Older adults are more vulnerable to opioid-associated morbidity. The purpose of this study was to determine the frequency and timing of acetaminophen and opioid use in the postoperative period.
Older adult trauma patients (≥65 years) with hip fractures requiring femur or hip fixation were reviewed (Premier Database 2008-2014). We examined rates of acetaminophen use on the day of surgery and prior to receipt of oral opioids. Mixed-effects linear regression models were used to examine the effects of an acetaminophen-first approach on opioid use the day prior to and on the day of discharge.
Of the 192 768 patients, 81.6% were Caucasian; 74.0% were female; and the mean age was 82.0 years [± 7.0]. Only 16.8% (32 291) of patients received acetaminophen prior to being prescribed opioids. 27.4% (52 779) received an acetaminophen-opioid combination, and 9.2% (17 730) received opioids without acetaminophen first. Acetaminophen first was associated with reduced opioid use on the day prior to and on the day of discharge (3.52 parenteral morphine equivalent doses (PMEs) less [95% CI: 3.33, 3.70]; < .0001). A statistically but not clinically significant reduction in length of stay was observed in the acetaminophen-first group.
Nearly 37% of older adult patients did not receive acetaminophen as first-line analgesia after hip surgery. Multimodal analgesia, including non-opioid medications as first-line, should be encouraged.
老年人更容易受到阿片类药物相关发病率的影响。本研究的目的是确定术后阿片类药物和对乙酰氨基酚的使用频率和时间。
对（Premier Database 2008-2014）髋部骨折需要股骨或髋关节固定的老年创伤患者（≥65 岁）进行回顾。我们检查了手术当天和口服阿片类药物前使用对乙酰氨基酚的比率。使用混合效应线性回归模型来检查在接受阿片类药物之前和出院当天使用对乙酰氨基酚的方法对阿片类药物使用的影响。
在 192768 名患者中，81.6%为白种人；74.0%为女性；平均年龄为 82.0 岁[±7.0]。只有 16.8%（32291 名）的患者在被开阿片类药物之前接受了对乙酰氨基酚。27.4%（52779 名）接受了对乙酰氨基酚-阿片类药物联合治疗，9.2%（17730 名）接受了没有首先使用对乙酰氨基酚的阿片类药物。首先使用对乙酰氨基酚与术前和出院当天阿片类药物用量减少相关（3.52 个注射吗啡等效剂量（PMEs）减少[95%CI：3.33，3.70]；<0.0001）。在首先使用对乙酰氨基酚的组中观察到住院时间略有但无统计学意义的减少。
近 37%的老年髋部手术后患者未接受对乙酰氨基酚作为一线镇痛药物。应鼓励使用包括非阿片类药物在内的多模式镇痛，作为一线药物。
