The association between initial opioid type and long-term opioid use after hip fracture surgery in elderly opioid-naïve patients
The association between initial opioid type and long-term opioid use after hip fracture surgery in elderly opioid-naïve patients
复制标题
未使用阿片类药物的老年患者髋部骨折术后初始阿片类药物类型与长期使用阿片类药物之间的关系
DOI：
10.1515/sjpain-2019-0170
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发表时间：
2020
影响因子：
1.6
通讯作者：
A. Pedersen
中科院分区：
文献类型：
--
作者：
A. Simoni;L. Nikolajsen;A. Olesen;C. Christiansen;S. Johnsen;A. Pedersen
摘要目的髋部骨折术后长期使用阿片类药物的老年患者已被证实使用阿片类药物。目前尚不清楚髋关节手术后赎回的阿片类型是否与长期使用阿片类药物有关。这项研究的目的是检查髋部骨折手术后前三个月内赎回的阿片类药物类型与手术后3-12个月阿片类药物使用之间的关系。方法利用丹麦卫生登记处(2005-2015)的数据，进行了一项基于人群的全国性队列研究。在丹麦多学科髋部骨折登记中登记的以前使用阿片类药物的天真患者，年龄65岁，在手术后三个月内兑换了≥1阿片类药物处方，纳入其中。长期使用阿片类药物的定义是在髋部骨折手术后一年内三个三个月内的每一次≥1赎回处方。术后长期使用阿片类药物的比例，以9个月的生存期为条件，根据术后3个月内的阿片类药物类型计算。以吗啡为参照物，以95%可信区间(CI)进行Logistic回归分析，计算不同阿片类药物的调整优势比(AOR)。亚组分析根据年龄、合并症和2010年前、后的日历时间进行。结果这项研究包括26,790名老年阿片类药物幼稚患者，在髋部骨折手术后3个月内使用阿片类药物。在这些患者中，21%的人在手术后九个月内死亡。在手术后9个月存活的21,255名患者中，15%成为长期阿片类药物使用者。与吗啡(9%)相比，术后前三个月内使用的某些阿片类药物与长期使用阿片类药物有关(9%)，包括羟考酮(14%，AOR；1.76，95%CI 1.52-2.03)、芬太尼(29%，AOR；4.37，95%CI 3.12-6.12)、可待因(13%，AOR；1.55，95%CI 1.14-2.09)、曲马多(13%，AOR；1.56，95%CI 1.35-1.80)、丁丙诺啡(33%，AOR；1.55，95%CI 1.14-2.09)、丁丙诺啡(33%，AOR；1.55，95%CI 1.14-2.09)、曲马多(13%，AOR；1.56，95%CI 1.35-1.80)、丁丙诺啡(33%，AOR；1.55，95%CI 1.14-2.09)、曲马多(13%，AOR；1.56，95%CI 1.35-1.80)、丁丙诺啡(33%，AOR；1.55，95%CI 1.14-2.09阿片型1例(27%，AOR；3.83，95%可信区间3.31~4.44)。长期使用阿片类药物的比例从2010年前的18%下降到2010年后的13%。结论髋部骨折术后某些阿片类药物的使用与长期使用阿片类药物的相关性大于吗啡，2010年后开始长期使用阿片类药物的比例下降。研究结果表明，一些老年阿片类药物天真的患者在医院接受髋部骨折手术时，似乎出现了未经治疗的疼痛状况。关于髋部骨折手术住院后开出的阿片类药物类型的决定可能与疼痛治疗的不同适应症有关，强调谨慎和认真的阿片类药物处方行为的可能性。
Abstract Objectives Long-term opioid use after hip fracture surgery has been demonstrated in previously opioid-naïve elderly patients. It is unknown if the opioid type redeemed after hip surgery is associated with long-term opioid use. The aim of this study was to examine the association between the opioid type redeemed within the first three months after hip fracture surgery and opioid use 3–12 months after the surgery. Methods A nationwide population-based cohort study was conducted using data from Danish health registries (2005–2015). Previously opioid-naïve patients registered in the Danish Multidisciplinary Hip Fracture Registry, aged ≥65 years, who redeemed ≥1 opioid prescription within three months after the surgery, were included. Long-term opioid use was defined as ≥1 redeemed prescription within each of three three-month periods within the year after hip fracture surgery. The proportion with long-term opioid use after surgery, conditioned on nine-month survival, was calculated according to opioid types within three months after surgery. Adjusted odds ratios (aOR) for different opioid types were computed by logistic regression analyses with 95% confidence intervals (CI) using morphine as reference. Subgroup analyses were performed according to age, comorbidity and calendar time before and after 2010. Results The study included 26,790 elderly, opioid-naïve patients with opioid use within three months after hip fracture surgery. Of these patients, 21% died within nine months after the surgery. Among the 21,255 patients alive nine months after surgery, 15% became long-term opioid users. Certain opioid types used within the first three months after surgery were associated with long-term opioid use compared to morphine (9%), including oxycodone (14%, aOR; 1.76, 95% CI 1.52–2.03), fentanyl (29%, aOR; 4.37, 95% CI 3.12–6.12), codeine (13%, aOR; 1.55, 95% CI 1.14–2.09), tramadol (13%, aOR; 1.56, 95% CI 1.35–1.80), buprenorphine (33%, aOR; 5.37, 95% CI 4.14–6.94), and >1 opioid type (27%, aOR; 3.83, 95% CI 3.31–4.44). The proportion of long-term opioid users decreased from 18% before 2010 to 13% after 2010. Conclusions The findings suggest that use of certain opioid types after hip fracture surgery is more associated with long-term opioid use than morphine and the proportion initiating long-term opioid use decreased after 2010. The findings suggest that some elderly, opioid-naïve patients appear to be presented with untreated pain conditions when seen in the hospital for a hip fracture surgery. Decisions regarding the opioid type prescribed after hospitalization for hip fracture surgery may be linked to different indication for pain treatment, emphasizing the likelihood of careful and conscientious opioid prescribing behavior.