Department of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR.
Fay W. Boozman College of Public Health, Department of Health Policy and Management, University of Arkansas for Medical Sciences, Little Rock, AR; Arkansas Department of Health, Little Rock, AR.
J Arthroplasty. 2022 Jul;37(7S):S530-S535. doi: 10.1016/j.arth.2022.01.071. Epub 2022 Feb 24.
While interest has focused on opioid use after total hip arthroplasty, little research has investigated opioid use in elderly patients after hip fracture. We hypothesize that a substantial number of opioid-naïve elderly patients go on to chronic opioid use after hip fracture surgery.
We reviewed a consecutive series of 219 patients 65 years and older who underwent surgical fixation between January 1, 2016 and February 28, 2019 for a native hip fracture. Patients were excluded for polytrauma, periprosthetic or pathologic fractures, recent major surgery, or death within 90 days of their hip surgery. The state prescription monitoring database was used to determine opioid use.
Overall, 58 patients (26%) were postoperative chronic opioid users. Of the initial 188 opioid-naïve patients, 43 (23%) became chronic users. Of the 31 preoperative opioid users, 15 (48%) continued as chronic users. Chronic postoperative users were more likely to be White (76% vs 91%, P = .04), younger (78 vs 82 years, P = .003), and preoperative opioid users (odds ratio 3.3, P = .007). Arthroplasty vs fixation did not affect the rate of chronic opioid use (P = .22).
Chronic opioid use is surprisingly common after hip fracture repair in the elderly. Twenty-three percent of opioid-naïve hip fracture patients became chronic users after surgery. Continued vigilance is needed by orthopedic surgeons to limit the amount and duration of postoperative narcotic prescriptions and to monitor for continued use.
虽然人们对全髋关节置换术后阿片类药物的使用兴趣浓厚，但很少有研究调查髋部骨折后老年患者的阿片类药物使用情况。我们假设相当数量的阿片类药物初治老年患者在髋部骨折手术后会继续使用慢性阿片类药物。
我们回顾了 2016 年 1 月 1 日至 2019 年 2 月 28 日期间接受手术内固定治疗的 219 名 65 岁及以上的原发性髋部骨折患者的连续系列。排除多发创伤、假体周围或病理性骨折、近期大手术或髋部手术后 90 天内死亡的患者。使用州处方监测数据库来确定阿片类药物的使用情况。
总体而言，58 名患者（26%）为术后慢性阿片类药物使用者。在最初的 188 名阿片类药物初治患者中，有 43 名（23%）成为慢性使用者。在 31 名术前阿片类药物使用者中，有 15 名（48%）继续作为慢性使用者。慢性术后使用者更有可能是白人（76%比 91%，P=0.04）、年龄更小（78 岁比 82 岁，P=0.003）和术前阿片类药物使用者（比值比 3.3，P=0.007）。关节置换术与内固定术并不影响慢性阿片类药物使用的发生率（P=0.22）。
髋部骨折修复后，老年人慢性阿片类药物的使用非常普遍。23%的阿片类药物初治髋部骨折患者在手术后成为慢性使用者。骨科医生需要继续保持警惕，限制术后阿片类药物处方的数量和持续时间，并监测持续使用情况。
