TY - JOUR
T1 - Risk factors for new chronic opioid use after hip fracture surgery
T2 - A Danish nationwide cohort study from 2005 to 2016 using the Danish multidisciplinary hip fracture registry
AU - Edwards, Nina Mc Kinnon
AU - Varnum, Claus
AU - Overgaard, Søren
AU - Nikolajsen, Lone
AU - Christiansen, Christian Fynbo
AU - Pedersen, Alma Becic
N1 - Publisher Copyright:
© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/3/8
Y1 - 2021/3/8
N2 - OBJECTIVE: To examine the risk factors for new chronic opioid use in elderly patients who underwent hip fracture surgery.DESIGN: Prospective population-based cohort study.SETTING AND PARTICIPANTS: 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.MAIN OUTCOME MEASURES: 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.RESULTS: 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.CONCLUSION: 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.
AB - OBJECTIVE: To examine the risk factors for new chronic opioid use in elderly patients who underwent hip fracture surgery.DESIGN: Prospective population-based cohort study.SETTING AND PARTICIPANTS: 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.MAIN OUTCOME MEASURES: 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.RESULTS: 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.CONCLUSION: 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.
KW - epidemiology
KW - hip
KW - pain management
KW - Denmark/epidemiology
KW - Prospective Studies
KW - Analgesics, Opioid/therapeutic use
KW - Humans
KW - Risk Factors
KW - Hip Fractures/epidemiology
KW - Registries
KW - Aged
KW - Cohort Studies
UR - http://www.scopus.com/inward/record.url?scp=85102270899&partnerID=8YFLogxK
U2 - 10.1136/bmjopen-2020-039238
DO - 10.1136/bmjopen-2020-039238
M3 - Journal article
C2 - 34006019
AN - SCOPUS:85102270899
SN - 2399-9772
VL - 11
JO - BMJ Paediatrics Open
JF - BMJ Paediatrics Open
IS - 3
M1 - e039238
ER -