Opioids in hip fracture patients: An analysis of mortality and post hospital opioid use

Lindestrand, Anna Gaki; Christiansen, Marie Louise Schougaard; Jantzen, Christopher; Mark, Susanne van der; Andersen, Stig Ejdrup

doi:10.1016/j.injury.2015.04.016

Cited by 35 publications

(53 citation statements)

References 24 publications

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“…(After After accounting for the duplicate studies, which appeared under various search headings, 230 distinct articles were identified. The review of the abstracts and/or full texts yielded 17 articles, which evaluated the risk of OUD from opioids administered perioperatively and were therefore retained for further analysis (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22). The excluded studies pertained to a range of topics including opioid sparing perioperative analgesic techniques, acute opioid tolerance, opioid induced hyperalgesia, perioperative use of ketamine, lidocaine and dexmedetomidine, and multimodal perioperative analgesia.…”

Section: Resultsmentioning

confidence: 99%

“…Phase of the Perioperative Opioid Administration: The studies reviewed described the perioperative opioid administration mainly in terms of opioid prescriptions given for a variable period spanning the time of surgery (Table 1). In three studies, these were any opioid prescriptions given for postoperative pain within 6 to 90 days of the hospital discharge (6)(7)(8). In eight studies, opioid prescriptions filled within 2 to 4 weeks prior to, and 1 to 2 weeks after the surgery, were considered as perioperative opioids; the prescriptions given preoperatively were included presumably to allow for those filled before the surgery for the perioperative use (9)(10)(11)(12)(13)(14)(15)(16).…”

Section: Resultsmentioning

confidence: 99%

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Risk of Opioid Use Disorder from Exposure to Opioids in the Perioperative Period: A Systematic Review

et al. 2020

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Opioid use disorder, a major source of morbidity and mortality globally, is regularly linked to opioids given around the time of surgery. Perioperative period, however, is markedly heterogeneous, with the diverse providers using opioids distinctively, and the various drivers of opioid misuse at-play dissimilarly, throughout the perioperative period. The risk of opioid use disorder may, therefore, be different from opioids given at the various phases of perioperative care, and the ensuing recommendations for their use may also be dissimilar. Systematic search and analysis of the pertinent literature, following the accepted standards, showed an overall increased risk of misuse from the perioperative opioids. However, the analyzed studies had significant methodological limitations, and were constrained mainly to the outpatient phase of the perioperative period. Lacking any data, this risk, therefore, is unknown for intraoperative and postoperative recovery periods. Consequently, no firm recommendations can be extended to anesthesia providers generally managing these perioperative stages. Furthermore, with significant methodological limitations, the current recommendations for opioid use after surgery are also arbitrary. Thus, though proposals for perioperative opioid use are formulated in this article, substantive recommendations would require clear delineation of these risks, while avoiding the limitations noted in this review.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Risk of Opioid Use Disorder from Exposure to Opioids in the Perioperative Period: A Systematic Review

et al. 2020

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“…However, we know from prior literature that the discharge opioid prescription is the most significant predictor of post‐discharge opioid use (Flanagan, Fuell, Ramey, Gunasekar, & Vallier, 2017). The effects of the discharge opioid prescription on long‐term opioid dependence in a geriatric hip fracture population are unclear (Lindestrand, Christiansen, Jantzen, van der Mark, & Andersen, 2015; Simoni, Nikolajsen, Olesen, Christiansen, & Pedersen, 2019; Torchia et al, 2019).…”

Section: Discussionmentioning

confidence: 99%

Factors associated with discharge opioid prescription after hip fracture fixation

Fandino

Bhashyam

Harris

et al. 2020

Musculoskeletal Care

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Objective Opioid prescribing after hip fracture fixation is variable, but the factors that drive this prescribing variation are not well‐described. The purpose of this study was to determine independent factors associated with increased opioid prescription upon discharge after hip fracture fixation. Methods A retrospective cohort study of 296 adult patients who underwent hip fracture fixation between January 2016 and December 2017 at two Level I trauma centers were included in our study. The primary outcome measurement was opioid prescription at discharge in morphine milligram equivalents (MME). Bivariate analysis was used to screen for factors, and multivariable regression analysis was used to identify independent factors associated with opioid prescription upon discharge from the hospital. Results Discharge opioid prescription amounts were available for 280 out of 296 patients (95%). The mean (±standard deviation) discharge opioid prescription was 212 (±319) MME. Multivariable regression analysis showed that younger age (p = 0.004), diabetes mellitus (p = 0.02), smoking (p < 0.001), treatment at hospital #2 (p < 0.001), and weekend discharge (p = 0.03) were associated with increased opioid prescription at discharge. Conclusions Increased opioid prescribing after hip fracture fixation is associated with patient‐ and system‐related factors. Prescriber education programs, prescription guidelines, and safe handoff practices that focus on these factors may help to decrease prescription variability and opioid overprescription across institutions.

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“…In addition, studies have shown that opioid-induced fractures are associated with time of use [5] and are also associated with the use of opioids [6]. Opioids have been linked to the occurrence of fractures [2,3,[7][8][9][10][11], and although the use of opioids has been reported to increase the risk of fractures, the trend of using opioids continues to increase [12].…”

Section: Introductionmentioning

confidence: 99%

An updated analysis of opioids increasing the risk of fractures

Yue

Teng

et al. 2020

PLoS ONE

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Objective To assess the relationship between opioid therapy for chronic noncancer pain and fracture risk by a meta-analysis of cohort studies and case-control studies. Methods The included cohort studies and case-control studies were identified by searching the PubMed and EMBASE databases from their inception until May 24, 2019. The outcome of interest was a fracture. This information was independently screened by two authors. When the heterogeneity among studies was significant, a random effects model was used to determine the overall combined risk estimate. Results In total, 12 cohort studies and 6 case-control studies were included. We used the Newcastle-Ottawa Scale (NOS) to evaluate the quality of the included literature, and 14 of the studies were considered high-quality studies. The overall relative risk of opioid therapy and fractures was 1.78 (95% confidence interval (CI) 1.53-2.07). Subgroup analyses revealed sources of heterogeneity, sensitivity analysis was stable, and no publication bias was observed. Conclusions The meta-analysis showed that the use of opioids significantly increased the risk of fracture.

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Opioids in hip fracture patients: An analysis of mortality and post hospital opioid use

Cited by 35 publications

References 24 publications

Risk of Opioid Use Disorder from Exposure to Opioids in the Perioperative Period: A Systematic Review

Risk of Opioid Use Disorder from Exposure to Opioids in the Perioperative Period: A Systematic Review

Factors associated with discharge opioid prescription after hip fracture fixation

An updated analysis of opioids increasing the risk of fractures

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