Relative risks of adverse events among older adults receiving opioids versus NSAIDs after hospital discharge: A nationwide cohort study.
Relative risks of adverse events among older adults receiving opioids versus NSAIDs after hospital discharge: A nationwide cohort study.
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DOI：
10.1371/journal.pmed.1003804
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发表时间：
2021-09
期刊：
影响因子：
15.8
通讯作者：
McCarthy EP
中科院分区：
文献类型：
--
作者：
Herzig SJ;Anderson TS;Jung Y;Ngo L;Kim DH;McCarthy EP
尽管每年有数百万成年人在出院时开始使用镇痛药，但在此过渡期间，定量阿片类药物和非甾体抗炎药（NSAID）在老年人中的风险的研究有限。我们试图确定出院后一周内有阿片类药物索赔的老年人与仅有NSAID索赔的老年人出院后不良事件的发生率和风险。我们使用2016年在美国医院住院的65岁及以上医疗保险受益人的全国样本进行了一项回顾性队列研究。我们排除了从设施接收或出院的受益人。我们得出了一个倾向性评分，其中包括100多个可能与镇痛药选择相关的因素，包括人口统计学，诊断，手术和药物联合给药。使用3：1倾向匹配，将出院后一周内有阿片类药物索赔的受益人（有或无NSAID索赔）与仅有NSAID索赔的受益人进行匹配。主要结局包括出院后30天内的死亡、医疗保健利用（急诊科[艾德]就诊和再住院）以及阿片类药物或NSAID的已知不良反应复合终点（跌倒/骨折、谵妄、恶心/呕吐、结肠动力减慢并发症、急性肾衰竭和胃炎/胃炎）。在倾向匹配后，阿片类药物队列有13，385名受益人，NSAID队列有4，677名受益人（平均年龄：74岁，57%为女性）。接受阿片类药物的受益者死亡率较高（1.8%对1.1%;相对风险[RR] 1.7 [1.3至2.3]，p < 0.001，需要伤害的人数[NNH] 125），医疗保健利用（19.0% vs 17.4%; RR 1.1 [1.02 - 1.2]，p = 0.02，NNH 59）和任何潜在不良反应（25.2%对21.3%; RR 1.2 [1.1至1.3]，p < 0.001，NNH 26），与仅服用NSAID的患者相比。具体来说，他们跌倒/骨折的相对风险更高，（4.5% vs 3.4%; RR 1.3 [1.1 - 1.6]，p = 0.002），恶心/呕吐（9.2%对7.3%; RR 1.3 [1.1至1.4]，p < 0.001）和结肠运动减慢（8.0%对6.2%; RR 1.3 [1.1至1.4]，p < 0.001）。谵妄、急性肾衰竭和胃炎/胃炎的风险在两组之间没有差异。我们研究的主要局限性是数据的观察性质和残余混杂的可能性。在出院后一周内填写阿片类药物处方的老年人与仅填写NSAID处方的老年人相比，死亡率和其他出院后不良结局的风险更高。在一项回顾性队列研究中，Shoshana Herzig及其同事调查了美国老年医疗保险受益人中阿片类镇痛药与NSAID相比的出院后不良事件的发生率和风险。在美国，每年有数百万老年人住院，并在出院时开具用于治疗疼痛的药物。阿片类药物和非甾体抗炎药（NSAID）是治疗疼痛最常用的药物之一，但它们具有风险。在这一脆弱的过渡时期，比较其风险的研究有限。我们使用美国最大的医疗保健支付者的记录来研究在出院后一周内接受阿片类药物或NSAID处方的老年人的全国样本。我们发现，与服用NSAID处方的老年人相比，服用阿片类药物处方的老年人死亡、医疗保健利用、福尔斯/骨折、恶心/呕吐和便秘相关并发症的风险更高。急性肾衰竭和上消化道并发症的风险在两组之间没有差异。我们的研究结果表明，与阿片类药物相比，NSAID与出院后对老年人的药物相关危害较少;然而，鉴于无法从观察性研究中推断因果关系，这些结果应在未来的研究中进行检验。对这些药物在因各种疾病住院的老年人中的有效性进行进一步研究将有助于进一步了解总体风险与受益比。
Although analgesics are initiated on hospital discharge in millions of adults each year, studies quantifying the risks of opioids and nonsteroidal anti-inflammatory drugs (NSAIDs) among older adults during this transition are limited. We sought to determine the incidence and risk of post-discharge adverse events among older adults with an opioid claim in the week after hospital discharge, compared to those with NSAID claims only. We performed a retrospective cohort study using a national sample of Medicare beneficiaries age 65 and older, hospitalized in United States hospitals in 2016. We excluded beneficiaries admitted from or discharged to a facility. We derived a propensity score that included over 100 factors potentially related to the choice of analgesic, including demographics, diagnoses, surgeries, and medication coadministrations. Using 3:1 propensity matching, beneficiaries with an opioid claim in the week after hospital discharge (with or without NSAID claims) were matched to beneficiaries with an NSAID claim only. Primary outcomes included death, healthcare utilization (emergency department [ED] visits and rehospitalization), and a composite of known adverse effects of opioids or NSAIDs (fall/fracture, delirium, nausea/vomiting, complications of slowed colonic motility, acute renal failure, and gastritis/duodenitis) within 30 days of discharge. After propensity matching, there were 13,385 beneficiaries in the opioid cohort and 4,677 in the NSAID cohort (mean age: 74 years, 57% female). Beneficiaries receiving opioids had a higher incidence of death (1.8% versus 1.1%; relative risk [RR] 1.7 [1.3 to 2.3], p < 0.001, number needed to harm [NNH] 125), healthcare utilization (19.0% versus 17.4%; RR 1.1 [1.02 to 1.2], p = 0.02, NNH 59), and any potential adverse effect (25.2% versus 21.3%; RR 1.2 [1.1 to 1.3], p < 0.001, NNH 26), compared to those with an NSAID claim only. Specifically, they had higher relative risk of fall/fracture (4.5% versus 3.4%; RR 1.3 [1.1 to 1.6], p = 0.002), nausea/vomiting (9.2% versus 7.3%; RR 1.3 [1.1 to 1.4], p < 0.001), and slowed colonic motility (8.0% versus 6.2%; RR 1.3 [1.1 to 1.4], p < 0.001). Risks of delirium, acute renal failure, and gastritis/duodenitis did not differ between groups. The main limitation of our study is the observational nature of the data and possibility of residual confounding. Older adults filling an opioid prescription in the week after hospital discharge were at higher risk for mortality and other post-discharge adverse outcomes compared to those filling an NSAID prescription only. In a retrospective cohort study, Shoshana Herzig and colleagues investigate the incidence and risk of post-hospital discharge adverse events among those with claims for opioid analgesics compared to NSAIDs among older Medicare beneficiaries in the US. Each year in the US, millions of older adults are hospitalized and prescribed medications intended for the treatment of pain on hospital discharge. Opioids and nonsteroidal anti-inflammatory drugs (NSAIDs) are among the most commonly used medications for the treatment of pain, but they carry risks. Studies comparing their risks during this vulnerable transition period are limited. We used records from the largest payer for healthcare in the US to study a nationwide sample of older adults who received an opioid or an NSAID prescription in the week after hospital discharge. We found that older adults filling an opioid prescription were at higher risk for death, healthcare utilization, falls/fractures, nausea/vomiting, and complications related to constipation, compared to those filling an NSAID prescription. Risk of acute renal failure and upper gastrointestinal complications did not differ between the groups. Our findings suggest that compared to opioids, NSAIDs are associated with fewer medication-related harms to older adults after discharge from the hospital; however, given that causality cannot be inferred from an observational study, these results should be tested in future studies. Additional research on the effectiveness of these medications among older adults hospitalized with various conditions would help to further understand overall risk to benefit ratio.
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影响因子：
6.3
作者：
Amatruda JG;Katz R;Peralta CA;Estrella MM;Sarathy H;Fried LF;Newman AB;Parikh CR;Ix JH;Sarnak MJ;Shlipak MG;Health ABC Study
通讯作者：
Health ABC Study
DOI：
10.1093/gerona/glx229
发表时间：
2018-07-01
影响因子：
5.1
作者：
Kim, Dae Hyun;Schneeweiss, Sebastian;Avorn, Jerry
通讯作者：
Avorn, Jerry
影响因子：
3
作者：
Franklin, Gary M.;Stover, Bert D.;Wickizer, Thomas M.
通讯作者：
Wickizer, Thomas M.
影响因子：
2.6
作者：
Herzig, Shoshana J.;Rothberg, Michael B.;Cheung, Michael;Ngo, Long H.;Marcantonio, Edward R.
通讯作者：
Marcantonio, Edward R.
影响因子：
--
作者：
McDonald, Janet;McBain, Lynn;Morris, Caroline
通讯作者：
Morris, Caroline