Patterns of Opioid Use in the 12 Months Following Geriatric Fragility Fractures: A Population-Based Cohort Study.
Patterns of Opioid Use in the 12 Months Following Geriatric Fragility Fractures: A Population-Based Cohort Study.
复制标题
老年脆性骨折后 12 个月内阿片类药物的使用模式：一项基于人群的队列研究。
DOI：
10.1016/j.jamda.2018.09.024
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发表时间：
2019
影响因子：
7.6
通讯作者：
Bell,John-Erik
中科院分区：
文献类型：
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作者：
Torchia,MichaelT;Munson,Jeffrey;Tosteson,TorD;Tosteson,AnnaNA;Wang,Qianfei;McDonough,ChristineM;Morgan,TamaraS;Bynum,JuliePW;Bell,John-Erik
髋关节、桡骨远端和肱骨近端骨折在医疗保险人群中很常见。本研究的目的是描述阿片类药物使用的模式和持续时间，包括使用的区域变化，在手术和非手术management.DesignPopulation-based队列study.Setting和participantsA队列阿片类药物初治的社区居住美国医疗保险受益人谁幸存的髋关节，桡骨远端，或肱骨近端骨折之间的2007年1月1日和2010年12月31日。队列成员被要求是阿片类药物初治4个月前fractures.MeasuresWe分析了患者的比例与积极的阿片类药物处方后，每个月的指数骨折，并报告在骨折后12个月继续填充。我们还比较了手术和非手术治疗骨折中阿片类药物处方的使用情况，并描述了骨折后3个月时阿片类药物处方使用的州级差异。结果该队列包括91，749名患者。髋部骨折患者在12个月时阿片类药物使用率最高（6.4%），其次是肱骨近端（5.7%）和桡骨远端（3.7%）。与非手术治疗的患者相比，接受肱骨近端和腕关节骨折手术固定的患者在术后前12个月的阿片类药物使用率更高。阿片类药物的使用有显着的变化，在国家一级，从7.6%至18.2%的骨折患者填写阿片类药物处方3个月后，指数fraction.Conclusions/ImplicationsOpioid初治患者维持脆性骨折的髋关节，肱骨近端，或桡骨远端的风险，继续对阿片类药物治疗12个月后，他们的指数损伤，肱骨近端和桡骨远端骨折的手术治疗增加了指数骨折后12个月内阿片类药物的使用。在非脊椎老年脆性骨折中，指数骨折后阿片类药物的消耗量存在显著的国家级变化。存在有针对性的质量改进工作的机会，以减少常见老年脆性骨折后阿片类药物使用的变化。
ObjectivesFractures of the hip, distal radius, and proximal humerus are common in the Medicare population. This study's objective was to characterize patterns and duration of opioid use, including regional variations in use, after both surgical and nonoperative management.DesignPopulation-based cohort study.Setting and participantsA cohort of opioid-naïve community-dwelling US Medicare beneficiaries who survived a hip, distal radius, or proximal humerus fracture between January 1, 2007 and December 31, 2010. Cohort members were required to be opioid-naïve for 4 months prior to fracture.MeasuresWe analyzed the proportion of patients with an active opioid prescription in each month following the index fracture, and report continued fills at 12 months postfracture. We also compared opioid prescription use in fractures treated surgically and nonsurgically and characterized state-level variation in opioid prescription use at 3 months postfracture.ResultsThere were 91,749 patients included in the cohort. Hip fracture patients had the highest rate of opioid use at 12 months (6.4%), followed by proximal humerus (5.7%), and distal radius (3.7%). Patients who underwent surgical fixation of proximal humerus and wrist fractures had higher rates of opioid use in each of the first 12 postoperative months compared with those managed nonoperatively. There was significant variation of opioid use at the state level, ranging from 7.6% to 18.2% of fracture patients filling opioid prescriptions 3 months after the index fracture.Conclusions/ImplicationsOpioid-naïve patients sustaining fragility fractures of the hip, proximal humerus, or distal radius are at risk to remain on opioid medications 12 months after their index injury, and surgical management of proximal humerus and distal radius fractures increases opioid use in the 12 months after the index fracture. There is significant state-level variation in opiate consumption after index fracture in nonvertebral geriatric fragility fractures. Opportunity exists for targeted quality improvement efforts to reduce the variation in opioid use following common geriatric fragility fractures.