scholarly journals 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

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e039238
Author(s):  
Nina McKinnon Edwards ◽  
Claus Varnum ◽  
Søren Overgaard ◽  
Lone Nikolajsen ◽  
Christian Fynbo Christiansen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Hip Fracture ◽  
Postoperative Treatment ◽  
Renal Diseases ◽  
First Year ◽  
Opioid Use ◽  
Hip Fracture Surgery ◽  
Chronic Opioid Use ◽  
Fracture Surgery

ObjectiveTo examine the risk factors for new chronic opioid use in elderly patients who underwent hip fracture surgery.DesignProspective population-based cohort study.Setting and participantsUsing 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 measuresNew 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.ResultsWe 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.ConclusionIn 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.

scholarly journals Opioid use after hip fracture surgery: A Danish nationwide cohort study from 2005 to 2015

2019 ◽  
Author(s):  
Amalie H. Simoni ◽  
Lone Nikolajsen ◽  
Anne E. Olesen ◽  
Christian. F. Christiansen ◽  
Alma B. Pedersen
Keyword(s):  
Cohort Study ◽  
Hip Fracture ◽  
Opioid Use ◽  
Hip Fracture Surgery ◽  
Fracture Surgery

scholarly journals The association between initial opioid type and long-term opioid use after hip fracture surgery in elderly opioid-naïve patients

2020 ◽  
Vol 20 (4) ◽  
pp. 755-764
Author(s):  
Amalie H. Simoni ◽  
Lone Nikolajsen ◽  
Anne E. Olesen ◽  
Christian F. Christiansen ◽  
Søren P. Johnsen ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Pain Treatment ◽  
Population Based ◽  
Opioid Use ◽  
Calendar Time ◽  
Opioid Prescription ◽  
Hip Fracture Surgery ◽  
Opioid Users ◽  
Fracture Surgery

AbstractObjectivesLong-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.MethodsA 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.ResultsThe 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.ConclusionsThe 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.

scholarly journals Preoperative risk factors for postoperative blood transfusion after hip fracture surgery: establishment of a nomogram

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Fu Cheng Bian ◽  
Xiao Kang Cheng ◽  
Yong Sheng An
Keyword(s):  
Risk Factors ◽  
Regression Analysis ◽  
Hip Fracture ◽  
Blood Transfusion ◽  
Multivariate Logistic Regression ◽  
Preoperative Risk ◽  
Hip Fracture Surgery ◽  
Preoperative Risk Factors ◽  
Independent Risk Factors ◽  
Fracture Surgery

Abstract Background This study aimed to explore the preoperative risk factors related to blood transfusion after hip fracture operations and to establish a nomogram prediction model. The application of this model will likely reduce unnecessary transfusions and avoid wasting blood products. Methods This was a retrospective analysis of all patients undergoing hip fracture surgery from January 2013 to January 2020. Univariate and multivariate logistic regression analyses were used to evaluate the association between preoperative risk factors and blood transfusion after hip fracture operations. Finally, the risk factors obtained from the multivariate regression analysis were used to establish the nomogram model. The validation of the nomogram was assessed by the concordance index (C-index), the receiver operating characteristic (ROC) curve, decision curve analysis (DCA), and calibration curves. Results A total of 820 patients were included in the present study for evaluation. Multivariate logistic regression analysis demonstrated that low preoperative hemoglobin (Hb), general anesthesia (GA), non-use of tranexamic acid (TXA), and older age were independent risk factors for blood transfusion after hip fracture operation. The C-index of this model was 0.86 (95% CI, 0.83–0.89). Internal validation proved the nomogram model’s adequacy and accuracy, and the results showed that the predicted value agreed well with the actual values. Conclusions A nomogram model was developed based on independent risk factors for blood transfusion after hip fracture surgery. Preoperative intervention can effectively reduce the incidence of blood transfusion after hip fracture operations.

scholarly journals Risk factors associated with outcomes of hip fracture surgery in elderly patients

2015 ◽  
Vol 68 (6) ◽  
pp. 561 ◽  
Author(s):  
Byung Hoon Kim ◽  
Sangseok Lee ◽  
Byunghoon Yoo ◽  
Woo Yong Lee ◽  
Yunhee Lim ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hip Fracture ◽  
Elderly Patients ◽  
Factors Associated ◽  
Hip Fracture Surgery ◽  
Fracture Surgery ◽  
Surgery In Elderly

scholarly journals Risk factors for extended length of stay following hip fracture surgery: A retrospective cohort study of patients aged 90 years and over in China

2019 ◽  
Author(s):  
Ling Lan ◽  
Li-jian Pei ◽  
Feifei Zhai ◽  
Yuelun Zhang ◽  
Jun Jing ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hip Fracture ◽  
Retrospective Cohort ◽  
Binary Logistic Regression ◽  
Postoperative Pneumonia ◽  
Binary Logistic Regression Analysis ◽  
Hip Fracture Surgery ◽  
Extended Length ◽  
Potential Risk Factors ◽  
Fracture Surgery

Abstract Background Hip fractures are typical fractures in geriatric patients and are associated with a high risk of postoperative complications and extended length of stay (LOS) compared with other osteoporotic fractures, particularly among patients over age 90. We aimed to identify the risk factors for extended LOS (more than 14 days) in patients older than 90 years. Methods A single-centre retrospective cohort study was performed in 50 patients (over age 90) who experienced hip fracture between June 1, 2013, and August 31, 2017. Their medical records were retrospectively reviewed from the hospital’s electronic database. The baseline characteristics of the patients, intraoperative data and postoperative complications were collected for the assessment of potential risk factors. Univariate analysis and multivariate binary logistic regression analysis were performed to determine potential risk factors for extended LOS. Results The age of the patients in the cohort ranged from 90 to 101 years, and the analysis demonstrated that 70% (n = 35) of the patients experienced a complicated course of treatment with an in-hospital mortality rate of 4% (n = 2). The most common complication was the occurrence of postoperative pneumonia (38%). The median duration of hospital stay was 18 (IQR 11, 21) days. Multivariate binary logistic regression analysis showed that a LOS of more than 14 days was significantly associated with a lower mean diastolic blood pressure during surgery [odds ratio (OR) =0.86, 95% confidence interval (CI)=0.76-0.98, P = 0.018] and the occurrence of postoperative pneumonia (OR=8.95, 95% CI=1.45-55.3, P = 0.018). The occurrence of postoperative pneumonia was significantly associated with the neutrophil-to-lymphocyte ratio (NLR) at admission (D0) [odds ratio (OR) =1.20, 95% confidence interval (CI)=1.02-1.41, P = 0.029]. Neither the LOS nor postoperative pneumonia was found to be associated with the anaesthesia technique. Conclusions A lower mean diastolic blood pressure during surgery and the occurrence of postoperative pneumonia may extend the LOS in patients aged 90 years and over who undergo hip fracture surgery. The use of regional anaesthesia was not associated with a shorter LOS.

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