Risk factors for new chronic opioid use after hip fracture surgery: a Danish nationwide cohort study from 2005 to 2016 using the Danish multidisciplinary hip fracture registry.
Risk factors for new chronic opioid use after hip fracture surgery: a Danish nationwide cohort study from 2005 to 2016 using the Danish multidisciplinary hip fracture registry.
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DOI：
10.1136/bmjopen-2020-039238
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发表时间：
2021-03-08
期刊：
影响因子：
2.9
通讯作者：
Pedersen AB
中科院分区：
文献类型：
--
作者：
Edwards NM;Varnum C;Overgaard S;Nikolajsen L;Christiansen CF;Pedersen AB
目的：研究老年髋部骨折手术患者新的慢性阿片类药物使用的危险因素。前瞻性人群队列研究。利用丹麦全国健康登记系统，我们确定了2005年至2016年期间接受过髋部骨折手术且在手术后第一年内存活的所有年龄为≥65岁的非阿片类药物非使用者患者。新的慢性阿片类药物使用的定义是在手术后第一年的最后三个季度中的两个季度内至少分发两个处方阿片类药物。我们确定了37名接受髋部骨折手术的 202阿片类药物非使用者患者。其中，5 497人(15%)在手术后1 内出现新的慢性阿片类药物使用者。新的慢性阿片类药物使用的危险因素是体重指数(BMI)；以BMI18.6~24.9为参照，BMI25.0~29.9(AOR1.12，95%CI1.04~1.21)，BMI30(AOR1.57，95%CI1.40~1.76)，股骨粗隆/粗隆下骨折(AOR1.27，95%CI1.20~1.34)。术前使用非类固醇抗炎药(AOR 1.68，95%CI 1.55至1.83)、选择性5-羟色胺再摄取抑制剂(AOR 1.42，95%CI 1.32至1.53)、抗抑郁药(AOR 1.36，95%CI 1.24至1.49)、抗精神病药物(AOR 1.21，95%CI 1.07至1.35)、皮质类固醇(AOR 1.54，95%CI 1.35至1.76)、他汀类药物(AOR 1.09，95%CI 1.02至1.18)，抗生素(AOR 1.32，95%CI 1.22~1.42)、抗骨质疏松药物(AOR 1.33，95%CI 1.19~1.49)和抗凝剂(AOR 1.24，95%CI 1.17~1.32)。心血管合并症、糖尿病、胃肠道疾病、痴呆症、慢性阻塞性肺疾病或肾脏疾病的存在进一步被确定为危险因素。在这项大规模的全国性队列研究中，我们在髋部骨折术后第一年内存活的患者中确定了与髋部骨折术后新的慢性阿片类药物使用相关的几个危险因素。虽然不是所有的因素在术前都是可以改变的，但这将允许临床医生对患者进行适当的术前咨询和量身定做术后治疗。
To examine the risk factors for new chronic opioid use in elderly patients who underwent hip fracture surgery. Prospective population-based cohort study. Using Danish nationwide health registries, we identified all opioid non-user patients aged ≥65 years who had undergone hip fracture surgery from 2005 to 2016 and were alive within the first year following surgery. New chronic opioid use defined by the dispensing of at least two prescription opioids within two of the last three quarters during the first year following surgery. We identified 37 202 opioid non-user patients who underwent hip fracture surgery. Of these, 5497 (15%) developed new chronic opioid user within 1 year of surgery. Risk factors for new chronic opioid use were Body Mass Index (BMI) of <18.5 (adjusted OR (aOR) 1.22, 95% CI 1.09 to 1.36), BMI of 25.0–29.9 (aOR 1.12, 95% CI 1.04 to 1.21) and BMI of ≥30 (aOR 1.57, 95% CI 1.40 to 1.76) with BMI 18.6–24.9 as reference, a pertrochanteric/subtrochanteric fracture (aOR 1.27, 95% CI 1.20 to 1.34) with femoral neck fracture as reference, preoperative use (vs no-use) of non-steroidal anti-inflammatory drug (aOR 1.68, 95% CI 1.55 to 1.83), selective serotonin reuptake inhibitor (aOR 1.42, 95% CI 1.32 to 1.53), antidepressants (aOR 1.36, 95% CI 1.24 to 1.49), antipsychotics (aOR 1.21, 95% CI 1.07 to 1.35), corticosteroids (aOR 1.54, 95% CI 1.35 to 1.76), statins (aOR 1.09, 95% CI 1.02 to 1.18), antibiotics (aOR 1.32, 95% CI 1.22 to 1.42), antiosteoporosis drugs (aOR 1.33, 95% CI 1.19 to 1.49) and anticoagulatives (aOR 1.24, 95% CI 1.17 to 1.32). Presence of cardiovascular comorbidities, diabetes, gastrointestinal diseases, dementia, chronic obstructive pulmonary disease or renal diseases was further identified as a risk factor. In this large nationwide cohort study, we identified several risk factors associated with new chronic opioid use after hip fracture surgery among patients who were alive within the first year following surgery. Although not all factors are modifiable preoperative, this will allow clinicians to appropriately counsel patients preoperatively and tailor postoperative treatment.
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影响因子：
4
作者：
Cooper, C.;Cole, Z. A.;Holroyd, C. R.;Earl, S. C.;Harvey, N. C.;Dennison, E. M.;Melton, L. J.;Cummings, S. R.;Kanis, J. A.
通讯作者：
Kanis, J. A.
DOI：
10.1136/bmj.g1251
发表时间：
2014-02-11
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Clarke H;Soneji N;Ko DT;Yun L;Wijeysundera DN
通讯作者：
Wijeysundera DN
影响因子：
2.9
作者：
Inacio MC;Hansen C;Pratt NL;Graves SE;Roughead EE
通讯作者：
Roughead EE
影响因子：
2.1
作者：
Kristensen, Morten Tange
通讯作者：
Kristensen, Morten Tange
影响因子：
3.7
作者：
Gjertsen, Jan-Erik;Dybvik, Eva;Engesaeter, Lars B.
通讯作者：
Engesaeter, Lars B.