Older patients may be at risk for chronic opioid use following hip fracture surgery
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SAN DIEGO — Results presented at the American Academy of Orthopaedic Surgeons Annual Meeting showed one in every six patients aged 60 years or older were still taking opioid pain medications 3 to 6 months after hip fracture surgery.
“While prior research on the hazards of opioids in the elderly has primarily focused on short-term risks, such as sedation and delirium, our findings suggest that addiction and chronic opioid usage may represent risks for this older population as well,” Kanu M. Okike, MD, orthopedic surgeon at Kaiser Permanente in Hawaii, told Healio Orthopedics.
Okike and colleagues retrospectively reviewed data for 29,618 patients aged 60 years or older with no prior use of opioid pain medications who underwent hip fracture surgery between 2009 and 2018. The goal was to determine how many patients went on to demonstrate prolonged opioid use following surgery. Prolonged opioid use was defined as filling one or more narcotic prescriptions in each time period of postoperative days 1 to 30, postoperative days 31 to 90 and postoperative days 91 to 180, according to Okike.
“We also conducted an analysis to determine if there were factors that made patients more likely to develop opioid usage,” Okike said.
Results showed 83.7%, 69% and 16.7% of patients filled one or more narcotic prescriptions between postoperative days 1 to 30, postoperative days 31 to 90 and postoperative days 91 to 180, respectively. Okike noted prolonged opioid usage was more common among patients aged 60 to 69 years, who were women or who had a BMI of 30 kg/m2 or more.
“Prolonged opioid usage was also more common among patients who smoked, had a greater number of medical comorbidities or had a history of substance abuse,” he said.
Patients who were Asian, had an annual income of $150,000 or more, or had undergone regional anesthesia were less likely to persistently use opioids after surgery, according to results. Researchers also found patients who underwent fracture fixation more commonly experienced persistent opioid usage, while patients who underwent total hip arthroplasty less commonly experienced persistent opioid usage.
“By understanding the risks of prolonged opioid usage in elderly hip fracture patients, orthopedic surgeons may be in a better position to modulate their prescribing patterns to minimize the risk going forward,” Okike said.
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Okike KM, et al. Paper 658. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; Aug. 31 – Sept. 3, 2021; San Diego.
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