title: Opioids in hip fracture patients: an analysis of mortality and post hospital opioid use.
abstract: OBJECTIVE
  The aim of this study was to investigate the use of opioids among hip fracture patients, and the potential relation between perioperative prescription of opioids, mortality and chronic opioid use. The purpose of this study was to investigate the use of opioids among hip fracture patients postoperatively and 90- and 180 days after discharge. The study also analysed predictors of early death at 30-, 90 and 365 days after discharge.
  
  
  METHODS
  We present data from the Orthopaedic Department at Bispebjerg University Hospital from 30 May 2010 and 31 March 2011 on 416 consecutively admitted hip fracture patients. Three patients died before surgery and were excluded from the analyses. Data were collected through medical records, hospital and national databases. Medication use was analysed before admission, at 3 and 6 months. Mortality data were analysed at 30 days, 6 months and 1 year.
  
  
  RESULTS
  24% were opioid users at admission, of whom 13% had an active malignant disease and 20% had been diagnosed with osteoporosis. 95% received opioids during admission, and 81% received a prescription for opioids at discharge. This fraction decreased to 36% at 3 months and 30% at 6 months. 2.9% of previous opioid naïve patients remained users at 6 months. Opioid use prior to admission and a pre-existing diagnosis of osteoporosis were the most significant factors associated with continued use at 3 and 6 months. The 30-day mortality was 10% and 1-year mortality was 27%. Mortality was associated with high age, ASA score>2, active cancer, high creatinine and leucocytosis. We found no association between opioids and mortality.
  
  
  CONCLUSIONS
  The results of our study indicate no general reason to refrain from prescribing opioids to hip fracture patients based on a fear of potential abuse or increased mortality.
authors.affiliation: Orthopaedic Department, Bispebjerg University Hospital, Denmark. Electronic address: agakilindestrand@gmail.com.
authors.forename: Anna Gaki
authors.initials: AG
authors.lastname: Lindestrand
authors.affiliation: Department of Clinical Pharmacology, Bispebjerg University Hospital, Denmark.
authors.forename: Marie Louise Schougaard
authors.initials: ML
authors.lastname: Christiansen
authors.affiliation: Orthopaedic Department, Bispebjerg University Hospital, Denmark.
authors.forename: Christopher
authors.initials: C
authors.lastname: Jantzen
authors.affiliation: Orthopaedic Department, Bispebjerg University Hospital, Denmark.
authors.forename: Susanne
authors.initials: S
authors.lastname: van der Mark
authors.affiliation: Unit of Clinical Pharmacology, Roskilde-Koege University Hospital, Denmark.
authors.forename: Stig Ejdrup
authors.initials: SE
authors.lastname: Andersen
mesh_terms: D000369:Aged, 80 and over; D000375:Aging; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D015897:Comorbidity; D003404:Creatinine / Q000097:blood; D003718:Denmark / Q000453:epidemiology; D005260:Female; D006620:Hip Fractures / Q000150:complications* / Q000209:etiology / Q000401:mortality; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007964:Leukocytosis / Q000401:mortality; D008297:Male; D009369:Neoplasms / Q000401:mortality; D010024:Osteoporosis / Q000150:complications*; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D011184:Postoperative Period; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D063487:Prescription Drug Misuse / Q000706:statistics & numerical data*; D012307:Risk Factors
chemical_list: D000701:Analgesics, Opioid; D003404:Creatinine
keywords: Addiction; Hip fracture; Mortality; Opioids