单独使用非甾体抗炎药、单独使用对乙酰氨基酚或两者联合使用的髋部骨折手术后的结果。
Outcomes after hip fracture surgery in patients receiving non-steroidal anti-inflammatory drugs alone, acetaminophen alone, or both.
机构信息
Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan.
出版信息
Bone Joint J. 2024 Aug 1;106-B(8):849-857. doi: 10.1302/0301-620X.106B8.BJJ-2024-0183.R1.
AIMS
The use of multimodal non-opioid analgesia in hip fractures, specifically acetaminophen combined with non-steroidal anti-inflammatory drugs (NSAIDs), has been increasing. However, the effectiveness and safety of this approach remain unclear. This study aimed to compare postoperative outcomes among patients with hip fractures who preoperatively received either acetaminophen combined with NSAIDs, NSAIDs alone, or acetaminophen alone.
METHODS
This nationwide retrospective cohort study used data from the Diagnosis Procedure Combination database. We included patients aged ≥ 18 years who underwent surgery for hip fractures and received acetaminophen combined with NSAIDs (combination group), NSAIDs alone (NSAIDs group), or acetaminophen alone (acetaminophen group) preoperatively, between April 2010 and March 2022. Primary outcomes were in-hospital mortality and complications. Secondary outcomes were opioid use postoperatively; readmission within 90 days, one year, and two years; and total hospitalization costs. We used propensity score overlap weighting models, with the acetaminophen group as the reference group.
RESULTS
We identified 93,018 eligible patients, including 13,068 in the combination group, 29,203 in the NSAIDs group, and 50,474 in the acetaminophen group. Propensity score overlap weighting successfully balanced patient characteristics among the three groups, with no significant difference in in-hospital mortality rates observed among the groups (combination group risk difference 0.0% (95% CI -0.5 to 0.4%); NSAIDs group risk difference -0.2% (95% CI -0.5 to 0.2%)). However, the combination group exhibited a significantly lower risk of in-hospital complications than the acetaminophen group (risk difference -1.9% (95% CI -3.2 to -0.6%)) as well as a significantly lower risk of deep vein thrombosis (risk difference -1.4% (95% CI -2.2 to -0.7%)). Furthermore, total hospitalization costs were higher in the NSAIDs group than in the acetaminophen group (difference USD $438 (95% CI 249 to 630); p < 0.001). No significant differences in other secondary outcomes were observed among the three groups.
CONCLUSION
The combination of acetaminophen with NSAIDs appears to be safe and advantageous in terms of reducing in-hospital complications.
目的
在髋部骨折中，多模式非阿片类镇痛的应用（特别是对乙酰氨基酚联合非甾体抗炎药（NSAIDs））正在增加。然而，这种方法的有效性和安全性仍不清楚。本研究旨在比较术前接受对乙酰氨基酚联合 NSAIDs、单独 NSAIDs 或单独对乙酰氨基酚治疗的髋部骨折患者的术后结局。
方法
这是一项全国性回顾性队列研究，使用了 Diagnosis Procedure Combination 数据库的数据。我们纳入了 2010 年 4 月至 2022 年 3 月期间年龄≥18 岁、接受髋部骨折手术且术前接受对乙酰氨基酚联合 NSAIDs（联合组）、单独 NSAIDs（NSAIDs 组）或单独对乙酰氨基酚（对乙酰氨基酚组）治疗的患者。主要结局为院内死亡率和并发症。次要结局为术后阿片类药物使用、90 天、1 年和 2 年内再入院以及总住院费用。我们使用倾向评分重叠加权模型，以对乙酰氨基酚组为参照组。
结果
我们共确定了 93018 名符合条件的患者，其中联合组 13068 例，NSAIDs 组 29203 例，对乙酰氨基酚组 50474 例。倾向评分重叠加权成功地平衡了三组患者的特征，各组之间的院内死亡率无显著差异（联合组风险差异 0.0%（95%CI-0.5 至 0.4%）；NSAIDs 组风险差异-0.2%（95%CI-0.5 至 0.2%））。然而，与对乙酰氨基酚组相比，联合组的院内并发症风险显著降低（风险差异-1.9%（95%CI-3.2 至-0.6%）），深静脉血栓形成风险也显著降低（风险差异-1.4%（95%CI-2.2 至-0.7%））。此外，与对乙酰氨基酚组相比，NSAIDs 组的总住院费用更高（差异 USD$438（95%CI 249 至 630）；p<0.001）。三组间其他次要结局无显著差异。
结论
在减少院内并发症方面，对乙酰氨基酚联合 NSAIDs 似乎是安全且有利的。
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