The use of opioids and laxatives, and incidence of constipation, in patients requiring neck-of-femur (NOF) surgery: a pilot study.
OBJECTIVE
Constipation is one of the most frequent adverse drug reactions occurring in hospital inpatients. There is no evidence base for the use of laxatives in orthopaedic patients on opioids. The aim of the study was to determine the current nature of opioid and laxative prescribing, and the incidence of constipation in patients who require emergency neck-of-femur (NOF) surgery.


METHODS
Patients admitted to the Royal Liverpool Hospital for emergency surgery for fractured NOF over an 8-week period in 2007 were included in the study. All opioid and laxative prescribing was recorded, alongside the incidence of constipation, nutritional status and mobility.


RESULTS
During the study period, 46 patients were eligible for inclusion. All patients received opioid analgesics. Constipation occurred in 33 patients (71.7%). Prophylactic laxatives were prescribed in 20 (43%) patients, 12 of whom developed constipation. Of the 26 (57%) patients not prescribed prophylaxis, 21 developed constipation (chi(2) = 2.3, P < 0.1 NS). Constipated patients were older (86 years vs. 76 years) (U = 112.5, P < 0.05), and had poorer nutritional status (2/13 vs. 16/33) (chi(2) = 4.28, P < 0.05), than patients without constipation.


CONCLUSIONS
This study demonstrates that age and nutritional status are significant factors influencing the occurrence of constipation, though the prophylactic use of laxatives did not alleviate the incidence of constipation. There is a clinical need to develop a robust evidence base surrounding the best management of constipation in this vulnerable group of orthopaedic patients.
Department of Pharmacy, Royal Liverpool Hospital, Prescot Street, Liverpool L15 4JT, UK. e.c.davies@2005.ljmu.ac.uk
E C
EC
Davies
C F
CF
Green
D R
DR
Mottram
M
M
Pirmohamed
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000009:adverse effects* / Q000627:therapeutic use; D003248:Constipation / Q000139:chemically induced* / Q000453:epidemiology / Q000517:prevention & control; D004632:Emergency Medical Services; D019317:Evidence-Based Medicine; D005260:Female; D005265:Femoral Neck Fractures / Q000601:surgery*; D006801:Humans; D054368:Laxatives / Q000627:therapeutic use*; D008131:London; D008297:Male; D009752:Nutritional Status; D010865:Pilot Projects; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data
D000701:Analgesics, Opioid; D054368:Laxatives