Long-term follow-up of opioid use in patients with acetabular fractures

Weiss, Rüdiger J; Montgomery, Scott; Stiller, Carl‐Olav; Wick, Marius C.; Jansson, Karl-Åke

doi:10.1016/j.injury.2012.03.027

Cited by 12 publications

(8 citation statements)

References 23 publications

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“…Long-term opioid therapy.-Prior research has used multiple operationalizations of LTOT, and there is no single agreed-upon definition [15,81]. In Sweden, opioid prescriptions are dispensed for a maximum of 3 months supply [66].…”

Section: 21mentioning

confidence: 99%

Associations of mental health and family background with opioid analgesic therapy: a nationwide Swedish register-based study

Quinn

Rickert

Franck

et al. 2019

Pain

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There is evidence of greater opioid prescription to individuals in the US with mental health conditions. Whether these associations generalize beyond the US prescription environment and to familial mental health and socioeconomic status (SES) has not been examined comprehensively. This study estimated associations of diverse pre-existing mental health diagnoses, parental mental health history, and SES in childhood with opioid analgesic prescription patterns nationwide in Sweden. Using register-based data, we identified 5 071 193 (48.4% female) adolescents and adults who were naïve to prescription opioid analgesics and followed them from 2007-2014. The cumulative incidence of any dispensed opioid analgesic within 3 years was 11.4% (95% CI, 11.3% −11.4%). Individuals with pre-existing self-injurious behavior, as well as opioid and other substance use, attention-deficit/hyperactivity, depressive, anxiety, and bipolar disorders, had greater opioid therapy initiation rates than did individuals without the respective conditions (hazard ratios from 1.24 [1.20-1.27] for bipolar disorder to 2.12 [2.04-2.21] for opioid use disorder). Among 1 298 083 opioid recipients, the cumulative incidence of long-term opioid therapy (LTOT) was 7.6% (7.6%−7.7%) within 3 years of initiation. All mental health conditions were associated with greater LTOT rates (hazard ratios from 1.66 [1.56-1.77] for bipolar disorder to 3.82 [3.51-4.15] for opioid use disorder) and were similarly associated with concurrent benzodiazepine-opioid therapy. Among 1 482 462 adolescents and young adults, initiation and

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Section: 21mentioning

confidence: 99%

Associations of mental health and family background with opioid analgesic therapy: a nationwide Swedish register-based study

Quinn

Rickert

Franck

et al. 2019

Pain

View full text Add to dashboard Cite

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“…For example, 39% of workers who filed a compensation claim and who received an opioid prescription remained on opioid therapy 1 year later [ 23 ]. Among patients with fractures, more than 40% and 30% continue taking prescribed opioids 6 and 12 months post-fracture, respectively [ 19 , 24 ].…”

Section: Introductionmentioning

confidence: 99%

Relative frequency and risk factors for long-term opioid therapy following surgery and trauma among adults: a systematic review protocol

et al. 2018

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BackgroundWhen patients have been on opioid therapy for more than 90 days, more than half of them continue using opioids years later. Knowing that long-term opioid consumption could lead to harmful side effects including misuse, abuse, and addiction, it is important to understand the risks of transitioning to prolonged opioid therapy to reduce its occurrence. Perioperative and trauma contexts are ideal models commonly used to study such transition. Long-term use of opioids might be associated with transformation of acute pain to chronic, which might be an example of a risk factor. The objectives of this knowledge synthesis are to examine the relative frequency and the risk factors for transitioning to long-term opioid therapy among patients who have undergone a surgical procedure or experienced a trauma.MethodsThe proposed study methodology is based on Preferred ReportIng Systematic Reviews and Meta-Analysis Protocols (PRISMA-P) statements on the conduct of systematic review and meta-analysis, the MOOSE Guidelines for Meta-Analyses and Systematic Reviews of Observational Studies, and the Cochrane Handbook for Systematic Review of Interventions. A systematic literature search will include multiple databases: Cochrane Central, EMBASE, MEDLINE, PsycINFO, CINHAL, PubMed, and the grey literature. We will identify studies related to opioid use beyond acute/subacute pain control after surgery or trauma. Two of the reviewers will screen all retrieved articles for eligibility and data extraction then critically appraise all identified studies. We will compile a narrative synthesis of all results and conduct a meta-analysis when feasible. As available data permits, we will perform a subgroup analysis of vulnerable populations.DiscussionThis systematic review will contribute to the prevention and harm reduction strategies associated with prescription opioids by identifying risk factors leading to the unwarranted long-term opioid therapy. The identification of common risk factors for long-term opioid therapy will help to orient further research on pain management as well as offer key therapeutic targets for the development of strategies to prevent prolonged opioid use.Systematic review registrationThis protocol was registered in PROSPERO on March 2, 2018; registration number CRD42012018089907.

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“…4 85% of hip fracture patients receive an opioid prescription at discharge, 10 and it has also been shown that the amount of opioids prescribed (oral morphine equivalents [OME]) increases with age. 2 Although a few studies have evaluated geriatric patients with acetabular and femoral shaft fractures, 11,12 these studies focused only on opioid naïve (ON) patients and excluded patients who had previous opioid exposure or had dementia and therefore do not provide a complete picture of the factors that could influence prolonged opioid use.…”

mentioning

confidence: 99%

A Retrospective Cohort Study on Chronic Opioid Use After Geriatric Hip Fracture Surgery—Risk Factors, Trends, and Outcomes

Stone

Pujari

Garlich

et al. 2023

J Am Acad Orthop Surg

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Introduction:The purpose of this study is to identify the risk factors for prolonged opioid use after surgery in geriatric hip fracture patients and the effects of prolonged use on mortality and readmission rates.Methods:An institutional registry was queried for all patients older than 65 years who underwent surgical treatment of a hip fracture between January 2016 and June 2017. Using the Controlled Substance Utilization Review and Evaluation System (CURES), we identified patients who had filled an opioid prescription within 3 months of hospital admission as opioid exposed and patients without a history of opioid use as opioid naïve (ON).Results:Of 500 patients who underwent hip-fracture surgery during the study period, a total of 322 had complete Controlled Substance Utilization Review and Evaluation System data. 36.0% (116) were OE, and 64.0% (206) were ON. 23.0% (74) patients filled an opioid prescription 6 months after surgery, 59.5% (44) were OE, and 40.5% (30) were ON. OE and patients on antidepressants were more likely to continue opioids at 6 months. Age, sex, fracture pattern, implant, benzodiazepine use, smoking, and alcohol status were not notable risk factors for prolonged opioid use. Antidepressant use was a risk factor for readmission within 90 days. Previous opioid exposure predicted mortality within 6 months.Discussion:Opioid use in geriatric hip fracture patients is high both preoperatively and postoperatively. Opioid exposed patients and patients on antidepressants are more likely to continue opioids at 6 months. A substantial proportion of ON patients became prolonged opioid users. Although prolonged opioid use postoperatively did not increase the risk of readmission or death, antidepressant use predicted readmission and previous opioid exposure predicted mortality. By identifying predictors of prolonged postoperative opioid use in geriatric hip fracture patients, we can better prepare physicians and their patients on what to expect in the postoperative period.Level of evidence:Level III

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Long-term follow-up of opioid use in patients with acetabular fractures

Cited by 12 publications

References 23 publications

Associations of mental health and family background with opioid analgesic therapy: a nationwide Swedish register-based study

Associations of mental health and family background with opioid analgesic therapy: a nationwide Swedish register-based study

Relative frequency and risk factors for long-term opioid therapy following surgery and trauma among adults: a systematic review protocol

A Retrospective Cohort Study on Chronic Opioid Use After Geriatric Hip Fracture Surgery—Risk Factors, Trends, and Outcomes

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