A descriptive analysis of rural seniors with femur and pelvis fractures and the impact of morphine milliequivalents on inpatient rehabilitation.

BACKGROUND

The US population ≥65 years old is rapidly growing. Geriatric disorders including hip fractures are becoming more numerous and the medical cost is significant. Hip fractures increase the risk of mortality in geriatric patients, but with improvements in medical care, this risk is declining over time. One important factor in the recovery and rehabilitation of hip fracture patients is pain management. Understanding the impact of opiate prescribing practices on outcomes in the rehabilitation setting can guide recommendations for the future.

MATERIALS AND METHODS

Patients ≥65 years old with hip fracture undergoing rehabilitation were retrospectively reviewed within the electronic health record. Information regarding gender, age, height, weight, BMI, length of stay, type of fracture, weight-bearing status, and comorbidities such as coronary artery disease, heart failure, chronic obstructive pulmonary disease, dementia, diabetes, renal disease, and vitamin D deficiency were obtained. The patients' morphine milligram equivalents were calculated and averaged by length of stay. This information was analyzed with the GG score along with patient-specific information above to assess for a relationship using odds ratio and Wald confidence intervals.

RESULTS

Of the studied ≥65-year-old patients (n = 115), the amount of MME weakly positively correlated, with the change in GG score for MME/day ( = 0.01), mobility ( = 0.02) and self-care ( = 0.03) scores. Age >85 years old ( = 0.002) and BMI <25 ( = 0.046) correlated with lower MMEs/day. Negative correlation with GG improvement was seen for age ( = 0.002), dementia ( < 0.001), and avitaminosis D ( = 0.01). Age ( = 0.001), dementia ( < 0.001), and avitaminosis D ( = 0.03) also correlated negatively with mobility, while only dementia ( < 0.001) and avitaminosis D ( = 0.004) correlated negatively with an overall score. Weight-bearing status displayed the most consistent positive correlation with overall ( = 0.009) and mobility ( = 0.04) scoring. Isolated positive impacts were seen with 'unknown' fracture types on mobility ( = 0.04), femur fractures on self-care ( = 0.047), and pubic rami fractures on self-care ( = 0.04).

CONCLUSIONS

A weak but significant correlation was seen between treatment with opioids and change in rehabilitation scoring. Age, dementia, and avitaminosis D correlated negatively in this rural, geriatric population, consistent with previous findings, while weight-bearing status and type of fracture had more positive correlations with functional scoring.