Risk Factors for Opioid-Related Adverse Drug Events Among Older Adults After Hospitalization for Major Orthopedic Procedures.
Risk Factors for Opioid-Related Adverse Drug Events Among Older Adults After Hospitalization for Major Orthopedic Procedures.
复制标题
老年人因主要骨科手术住院后发生阿片类药物相关不良药物事件的危险因素。
DOI：
10.1097/pts.0000000000001144
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发表时间：
2023
影响因子：
2.2
通讯作者：
McCarthy,EllenP
中科院分区：
文献类型：
--
作者：
Herzig,ShoshanaJ;Anderson,TimothyS;Urman,RichardD;Jung,Yoojin;Ngo,LongH;McCarthy,EllenP
目的：接受骨科手术的老年人通常因阿片类药物而出院，但出院后阿片类药物相关不良事件（ORADEs）的危险因素此前尚未研究过。我们的目的是确定骨科手术后出院后发生ORADEs的危险因素。方法本研究是一项回顾性队列研究，研究对象为65岁及以上的医保受益人，他们在2016年住院期间接受了重大骨科手术，出院后2天内服用了阿片类药物。我们排除了有临终关怀索赔的受益人和那些从医院入院或出院的受益人。我们使用账单代码和药物声明来定义出院后30天内需要医院复诊的潜在orade。结果在30,514例主要骨科手术（89.7%为关节置换术，5.6%为骨折脱位治疗，4.7%为其他）和阿片类药物索赔的住院患者中，750例（2.5%）发生了潜在的ORADE，需要再次住院。独立危险因素包括年龄80岁及以上（风险比[HR]， 1.65； 95%可信区间，1.38-1.97）、女性（HR, 1.34[1.16-1.56]）和临床状况，包括心力衰竭（HR, 1.34[1.10-1.62]）、呼吸系统疾病（HR, 1.23[1.03-1.46]）、肾脏疾病（HR, 1.23[1.04-1.47]）、痴呆/谵妄（HR, 1.63[1.26-2.10]）、焦虑症（HR, 1.42[1.18-1.71]）、肌肉骨骼/神经系统损伤（HR, 1.54[1.24-1.90]）。调整患者特征后，既往阿片类药物使用、处方镇静剂和阿片类药物处方特征与ORADEs无关。结论骨科术后使用阿片类药物出院的老年人有2.5%发生潜在的不良反应。这些风险因素可以为临床医生的决策、与老年人的对话以及减少危害策略的目标提供信息。
ObjectivesOlder adults undergoing orthopedic procedures are commonly discharged from the hospital on opioids, but risk factors for postdischarge opioid-related adverse drug events (ORADEs) have not been previously examined. We aimed to identify risk factors for ORADEs after hospital discharge following orthopedic procedures.MethodsThis is a retrospective cohort study of a national sample of Medicare beneficiaries 65 years or older, who underwent major orthopedic surgery during hospitalization in 2016 and had an opioid fill within 2 days of discharge. We excluded beneficiaries with hospice claims and those admitted from or discharged to a facility. We used billing codes and medication claims to define potential ORADEs requiring a hospital revisit within 30 days of discharge.ResultsAmong 30,514 hospitalizations with a major orthopedic procedure (89.7% arthroplasty, 5.6% treatment of fracture of dislocation, 4.7% other) and an opioid claim, a potential ORADE requiring hospital revisit occurred in 750 (2.5%). Independent risk factors included age of 80 years or older (hazard ratio [HR], 1.65; 95% confidence interval, 1.38–1.97), female sex (HR, 1.34 [1.16–1.56]), and clinical conditions, including heart failure (HR, 1.34 [1.10–1.62]), respiratory illness (HR, 1.23 [1.03–1.46]), kidney disease (HR, 1.23 [1.04–1.47]), dementia/delirium (HR, 1.63 [1.26–2.10]), anxiety disorder (HR, 1.42 [1.18–1.71]), and musculoskeletal/nervous system injuries (HR, 1.54 [1.24–1.90]). Prior opioid use, coprescribed sedating medications, and opioid prescription characteristics were not associated with ORADEs after adjustment for patient characteristics.ConclusionsPotential ORADEs occurred in 2.5% of older adults discharged with opioids after orthopedic surgery. These risk factors can inform clinician decision making, conversations with older adults, and targeting of harm reduction strategies.