Time trends in opioid use for patients undergoing hip fracture surgery in 1997–2018: A Danish population-based cohort study

IF 3.5 2区医学 Q1 ANESTHESIOLOGY European Journal of Pain Pub Date : 2024-04-06 DOI:10.1002/ejp.2271

I. M. Melsen, S. K. Szépligeti, P. H. Gundtoft, A. B. Pedersen

{"title":"Time trends in opioid use for patients undergoing hip fracture surgery in 1997–2018: A Danish population-based cohort study","authors":"I. M. Melsen, S. K. Szépligeti, P. H. Gundtoft, A. B. Pedersen","doi":"10.1002/ejp.2271","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>Although opioids are a mainstay for perioperative pain management in hip fracture patients, no studies have described changes in opioid use over the last two decades. The aim of this study was to describe time trends in opioid use in a population-based cohort of patients undergoing a first-time hip fracture surgery during 1997–2018.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>Opioid-naïve hip fracture patients >55 years old were identified in Danish medical databases (<i>n</i> = 115,962). By 2-year calendar periods, we calculated prevalence rates (PR) of opioid use in the four quarters after surgery (Q1–Q4). Corresponding prevalence rate ratios (PRR) with 1997–1998 as a reference were estimated with 95% confidence intervals. Further, we calculated the median morphine milligram equivalents (MME) for each quarter.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>For Q1, the PR of opioid use increased from 29% in 1997–1998 to 78% in 2017–2018 corresponding to a PRR of 2.7 (2.6–2.8). For Q4, the PR was 15% in 1997–1998, peaked in 2003–2004 and then decreased, but stayed high at 13% in 2017–2018. The median MME did not increase when comparing 2017–2018 with 1997–1998, irrespective of the quarter. Tramadol was most frequently used in 1997–1998 shifting to oxycodone in 2017–2018.</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>The PRs of opioid use in Q1 after surgery increased substantially from 1997 to 2018, but this did not translate into increased opioid use up to 1 year after hip fracture surgery or higher dosage. Our findings underline the importance of sustained focus on opioid tapering, dosage and use of opioids with the lowest potential for addiction and other adverse events.</p>\n </section>\n \n <section>\n \n <h3> Significance Statement</h3>\n \n <p>Overall, opioid use in Q1 after hip fracture surgery increased 2.7 times from 1997 to 2018, but the doses and opioid use up to 1 year after surgery remained stable. Compared to elderly, younger patients were more likely to use opioid in Q1, while the tendency was opposite in Q2–Q4. The most used opioid type changed from tramadol to oxycodone. Our findings underline the importance of personalized opioid tapering and doses, and use of opioids with the lowest potential for addiction and other adverse events.</p>\n </section>\n </div>","PeriodicalId":12021,"journal":{"name":"European Journal of Pain","volume":"28 9","pages":"1486-1496"},"PeriodicalIF":3.5000,"publicationDate":"2024-04-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ejp.2271","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Journal of Pain","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/ejp.2271","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Although opioids are a mainstay for perioperative pain management in hip fracture patients, no studies have described changes in opioid use over the last two decades. The aim of this study was to describe time trends in opioid use in a population-based cohort of patients undergoing a first-time hip fracture surgery during 1997–2018.

Methods

Opioid-naïve hip fracture patients >55 years old were identified in Danish medical databases (n = 115,962). By 2-year calendar periods, we calculated prevalence rates (PR) of opioid use in the four quarters after surgery (Q1–Q4). Corresponding prevalence rate ratios (PRR) with 1997–1998 as a reference were estimated with 95% confidence intervals. Further, we calculated the median morphine milligram equivalents (MME) for each quarter.

Results

For Q1, the PR of opioid use increased from 29% in 1997–1998 to 78% in 2017–2018 corresponding to a PRR of 2.7 (2.6–2.8). For Q4, the PR was 15% in 1997–1998, peaked in 2003–2004 and then decreased, but stayed high at 13% in 2017–2018. The median MME did not increase when comparing 2017–2018 with 1997–1998, irrespective of the quarter. Tramadol was most frequently used in 1997–1998 shifting to oxycodone in 2017–2018.

Conclusion

The PRs of opioid use in Q1 after surgery increased substantially from 1997 to 2018, but this did not translate into increased opioid use up to 1 year after hip fracture surgery or higher dosage. Our findings underline the importance of sustained focus on opioid tapering, dosage and use of opioids with the lowest potential for addiction and other adverse events.

Significance Statement

Overall, opioid use in Q1 after hip fracture surgery increased 2.7 times from 1997 to 2018, but the doses and opioid use up to 1 year after surgery remained stable. Compared to elderly, younger patients were more likely to use opioid in Q1, while the tendency was opposite in Q2–Q4. The most used opioid type changed from tramadol to oxycodone. Our findings underline the importance of personalized opioid tapering and doses, and use of opioids with the lowest potential for addiction and other adverse events.

Abstract Image

查看原文

微信好友朋友圈 QQ好友复制链接

本刊更多论文

1997-2018年髋部骨折手术患者阿片类药物使用的时间趋势：一项基于丹麦人口的队列研究

背景虽然阿片类药物是髋部骨折患者围手术期疼痛治疗的主要药物，但过去二十年来没有任何研究描述过阿片类药物使用的变化。本研究旨在描述 1997-2018 年间首次接受髋部骨折手术患者人群队列中阿片类药物使用的时间趋势。方法从丹麦医疗数据库（n = 115962）中识别出 55 岁的髋部骨折患者。我们按 2 年日历期计算了术后四个季度（Q1-Q4）的阿片类药物使用流行率 (PR)。以 1997-1998 年为参照，我们估算出了相应的流行率比（PRR），并得出了 95% 的置信区间。此外，我们还计算了每个季度的吗啡毫克当量（MME）中位数。结果在第一季度，阿片类药物使用的流行率从1997-1998年的29%上升至2017-2018年的78%，对应的流行率比为2.7（2.6-2.8）。就第四季度而言，1997-1998年的PR为15%，2003-2004年达到峰值，随后有所下降，但在2017-2018年保持在13%的高位。2017-2018年与1997-1998年相比，无论哪个季度，MME中位数都没有增加。1997-1998年使用最多的是曲马多，2017-2018年则转为羟考酮。结论从1997年到2018年，术后第一季度阿片类药物使用的PRs大幅增加，但这并没有转化为髋部骨折术后1年内阿片类药物使用的增加或剂量的增加。我们的研究结果强调了持续关注阿片类药物减量、剂量以及使用成瘾和其他不良事件可能性最低的阿片类药物的重要性。重要意义声明总体而言，髋部骨折术后第一季度的阿片类药物使用量从 1997 年到 2018 年增加了 2.7 倍，但术后 1 年内的剂量和阿片类药物使用量保持稳定。与老年患者相比，年轻患者在第一季度更倾向于使用阿片类药物，而在第二至第四季度的趋势则相反。使用最多的阿片类药物从曲马多变为羟考酮。我们的研究结果凸显了个性化阿片类药物减量和剂量以及使用成瘾和其他不良反应可能性最低的阿片类药物的重要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文去求助

来源期刊

European Journal of Pain 医学-临床神经学

CiteScore

7.50

自引率

5.60%

发文量

163

审稿时长

4-8 weeks

期刊介绍： European Journal of Pain (EJP) publishes clinical and basic science research papers relevant to all aspects of pain and its management, including specialties such as anaesthesia, dentistry, neurology and neurosurgery, orthopaedics, palliative care, pharmacology, physiology, psychiatry, psychology and rehabilitation; socio-economic aspects of pain are also covered. Regular sections in the journal are as follows: • Editorials and Commentaries • Position Papers and Guidelines • Reviews • Original Articles • Letters • Bookshelf The journal particularly welcomes clinical trials, which are published on an occasional basis. Research articles are published under the following subject headings: • Neurobiology • Neurology • Experimental Pharmacology • Clinical Pharmacology • Psychology • Behavioural Therapy • Epidemiology • Cancer Pain • Acute Pain • Clinical Trials.