Extended opioid usage occurred in older patients, aged 60 years and up, who undergo fracture surgery, according to a study presented at the 2021 Virtual Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS).
Investigators looked at 29,618 patients who were naïve to opioids and underwent hip fracture surgery between 2009 and 2018 at 1 of 35 hospitals in the Kaiser Permanente health maintenance organisation. They followed patients to determine opioid usage, classifying patients according to filling prescriptions in 3 time periods: 0 to 30 days after surgery, 31 to 90 days after surgery, and 91 to 180 days after surgery. Patients had a median age of 82 years and 70.7% were female.
“While prior studies have found prolonged opioid usage and addiction to be risks for young patients who sustain fractures and undergo surgery, most studies of opioids in older patients have focused on short-term risks such as oversedation and delirium,” said Kanu Okike MD, Hawaii Permanente Medical Group, Honolulu, Hawaii. “Our hypothesis was that prolonged opioid usage could be a risk for older patients as well.”
The investigators found that the proportion of opioid usage was 83.7% in the first time period, 69% in the second time period, and 16.7% in the third time period. A total of 3,137 patients died before the second time period.
Risk factors that emerged for persistent opioid usage included being aged 60 to 69 years, being female, having a body mass index of at least 30, current or past smoking, a history of substance abuse, and an American Society of Anesthesiologists physical status classification of at least 3, denoting a patient with severe systemic disease.
Investigators also looked at the impact of surgery type and found ongoing opioid usage was more common in those who underwent fracture fixation (2,794/15,796) and less common in those after total hip arthroplasty (94/717), with both compared to hemiarthroplasty (1,488/9,542).
The findings suggest about 1 of every 6 older patients who had surgery for hip fracture were still taking opioids for pain 3 to 6 months postoperatively.
“Specific guidelines for the duration of opioids after hip fracture do not exist, but some have suggested that four weeks may be a reasonable target for weaning patients off opioid pain medications following fracture surgery,” said Dr. Okike.
He noted the retrospective nature of the study limits the robustness of the findings.
“Our findings should be taken to represent association and not necessarily causation,” said Dr. Okike. “We controlled for a variety of confounders, but there is still the possibility of residual confounding or incomplete controlling.”