From the California University of Science and Medicine, Colton, CA (Stone) and the Cedars-Sinai Medical Center, Los Angeles, CA (Pujari, Garlich, and Lin).
J Am Acad Orthop Surg. 2023 Mar 15;31(6):312-318. doi: 10.5435/JAAOS-D-22-00458. Epub 2023 Jan 2.
The purpose of this study is to identify the risk factors for prolonged opioid use after surgery in geriatric hip fracture patients and the effects of prolonged use on mortality and readmission rates.
An institutional registry was queried for all patients older than 65 years who underwent surgical treatment of a hip fracture between January 2016 and June 2017. Using the Controlled Substance Utilization Review and Evaluation System (CURES), we identified patients who had filled an opioid prescription within 3 months of hospital admission as opioid exposed and patients without a history of opioid use as opioid naïve (ON).
Of 500 patients who underwent hip-fracture surgery during the study period, a total of 322 had complete Controlled Substance Utilization Review and Evaluation System data. 36.0% (116) were OE, and 64.0% (206) were ON. 23.0% (74) patients filled an opioid prescription 6 months after surgery, 59.5% (44) were OE, and 40.5% (30) were ON. OE and patients on antidepressants were more likely to continue opioids at 6 months. Age, sex, fracture pattern, implant, benzodiazepine use, smoking, and alcohol status were not notable risk factors for prolonged opioid use. Antidepressant use was a risk factor for readmission within 90 days. Previous opioid exposure predicted mortality within 6 months.
Opioid use in geriatric hip fracture patients is high both preoperatively and postoperatively. Opioid exposed patients and patients on antidepressants are more likely to continue opioids at 6 months. A substantial proportion of ON patients became prolonged opioid users. Although prolonged opioid use postoperatively did not increase the risk of readmission or death, antidepressant use predicted readmission and previous opioid exposure predicted mortality. By identifying predictors of prolonged postoperative opioid use in geriatric hip fracture patients, we can better prepare physicians and their patients on what to expect in the postoperative period.
Level III.
本研究旨在确定老年髋部骨折患者手术后长期使用阿片类药物的风险因素，以及长期使用对死亡率和再入院率的影响。
通过查询 2016 年 1 月至 2017 年 6 月期间接受髋关节骨折手术治疗的所有 65 岁以上患者的机构登记处，我们使用受控物质利用审查和评估系统（CURES）来识别在入院后 3 个月内填写阿片类药物处方的患者（暴露于阿片类药物）和没有阿片类药物使用史的患者（未使用过阿片类药物）。
在研究期间接受髋关节手术的 500 名患者中，共有 322 名患者有完整的受控物质利用审查和评估系统数据。36.0%（116 人）为 OE，64.0%（206 人）为 ON。23.0%（74 人）的患者在手术后 6 个月时开具了阿片类药物处方，其中 59.5%（44 人）为 OE，40.5%（30 人）为 ON。OE 和使用抗抑郁药的患者更有可能在 6 个月时继续使用阿片类药物。年龄、性别、骨折模式、植入物、苯二氮䓬类药物的使用、吸烟和酒精状况并不是长期使用阿片类药物的显著危险因素。抗抑郁药的使用是 90 天内再入院的危险因素。以前使用过阿片类药物是 6 个月内死亡的预测因素。
老年髋部骨折患者术前和术后阿片类药物的使用都很高。暴露于阿片类药物的患者和使用抗抑郁药的患者更有可能在 6 个月时继续使用阿片类药物。相当一部分 ON 患者成为长期使用阿片类药物的患者。尽管术后长期使用阿片类药物不会增加再入院或死亡的风险，但抗抑郁药的使用预测了再入院，而以前使用过阿片类药物则预测了死亡率。通过确定老年髋部骨折患者术后长期使用阿片类药物的预测因素，我们可以更好地让医生及其患者了解术后期间的预期情况。
3 级。
