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 3-12months 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.
Highlights
Hip fracture surgery is frequent in the elderly population with an incidenced rate of up to four cases per 1,000This work is licensed under the Creative Commons Attribution 4.0Simoni et al.: Opioid use after hip fracture surgery person-years in Denmark [1]
The findings suggest that use of certain opioid types after hip fracture surgery is more associated with longterm 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
Summary
Hip fracture surgery is frequent in the elderly population with an incidenced rate of up to four cases per 1,000This work is licensed under the Creative Commons Attribution 4.0Simoni et al.: Opioid use after hip fracture surgery person-years in Denmark [1]. Another study has shown that 17% of previously opioid-naïve patients redeemed opioid prescriptions within 9–12 months after hip fracture surgery, and 8% of previously opioid-naïve patients continued redeeming opioid prescriptions in all four quarters after the surgery [5] Opioid use both in Denmark and worldwide seems closely linked to the level of pain and aging in the population [6]. The present study hypothesize that the prescribers behavior and choice of opioid types after hip fracture surgery in elderly patients, is linked to the need of opioid therapy the year after surgery for the individual patients, and opioid prescribing behavior have changed as the public focus on misuse, addiction, and withdrawal has increased
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