Outcomes after hip fracture surgery in patients receiving non-steroidal anti-inflammatory drugs alone, acetaminophen alone, or both.

IF 4.9 1区医学 Q1 ORTHOPEDICS

Bone & Joint Journal Pub Date : 2024-08-01 DOI:10.1302/0301-620X.106B8.BJJ-2024-0183.R1

Masaki Hatano, Yusuke Sasabuchi, Hisatoshi Ishikura, Hideaki Watanabe, Takeyuki Tanaka, Sakae Tanaka, Hideo Yasunaga

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引用次数: 0

Abstract

Aims: The use of multimodal non-opioid analgesia in hip fractures, specifically acetaminophen combined with non-steroidal anti-inflammatory drugs (NSAIDs), has been increasing. However, the effectiveness and safety of this approach remain unclear. This study aimed to compare postoperative outcomes among patients with hip fractures who preoperatively received either acetaminophen combined with NSAIDs, NSAIDs alone, or acetaminophen alone.

Methods: This nationwide retrospective cohort study used data from the Diagnosis Procedure Combination database. We included patients aged ≥ 18 years who underwent surgery for hip fractures and received acetaminophen combined with NSAIDs (combination group), NSAIDs alone (NSAIDs group), or acetaminophen alone (acetaminophen group) preoperatively, between April 2010 and March 2022. Primary outcomes were in-hospital mortality and complications. Secondary outcomes were opioid use postoperatively; readmission within 90 days, one year, and two years; and total hospitalization costs. We used propensity score overlap weighting models, with the acetaminophen group as the reference group.

Results: We identified 93,018 eligible patients, including 13,068 in the combination group, 29,203 in the NSAIDs group, and 50,474 in the acetaminophen group. Propensity score overlap weighting successfully balanced patient characteristics among the three groups, with no significant difference in in-hospital mortality rates observed among the groups (combination group risk difference 0.0% (95% CI -0.5 to 0.4%); NSAIDs group risk difference -0.2% (95% CI -0.5 to 0.2%)). However, the combination group exhibited a significantly lower risk of in-hospital complications than the acetaminophen group (risk difference -1.9% (95% CI -3.2 to -0.6%)) as well as a significantly lower risk of deep vein thrombosis (risk difference -1.4% (95% CI -2.2 to -0.7%)). Furthermore, total hospitalization costs were higher in the NSAIDs group than in the acetaminophen group (difference USD $438 (95% CI 249 to 630); p < 0.001). No significant differences in other secondary outcomes were observed among the three groups.

Conclusion: The combination of acetaminophen with NSAIDs appears to be safe and advantageous in terms of reducing in-hospital complications.

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单纯服用非甾体类抗炎药、单纯服用对乙酰氨基酚或同时服用这三种药物的患者髋部骨折手术后的疗效。

目的：在髋部骨折中使用多模式非阿片类药物镇痛，特别是对乙酰氨基酚联合非甾体抗炎药（NSAIDs）的情况越来越多。然而，这种方法的有效性和安全性仍不明确。本研究旨在比较术前接受对乙酰氨基酚联合非甾体抗炎药、单纯非甾体抗炎药或单纯对乙酰氨基酚治疗的髋部骨折患者的术后效果：这项全国性的回顾性队列研究使用了诊断程序组合数据库中的数据。我们纳入了 2010 年 4 月至 2022 年 3 月期间年龄≥ 18 岁、因髋部骨折接受手术且术前接受对乙酰氨基酚联合非甾体抗炎药（联合组）、单独使用非甾体抗炎药（非甾体抗炎药组）或单独使用对乙酰氨基酚（对乙酰氨基酚组）治疗的患者。主要结果为院内死亡率和并发症。次要结果是术后阿片类药物的使用；90 天内、一年内和两年内的再入院情况；以及住院总费用。我们采用倾向得分重叠加权模型，以对乙酰氨基酚组为参照组：我们确定了 93,018 名符合条件的患者，其中 13,068 人属于联合用药组，29,203 人属于非甾体抗炎药组，50,474 人属于对乙酰氨基酚组。倾向得分重叠加权法成功地平衡了三组患者的特征，观察到三组患者的院内死亡率无显著差异（联合用药组风险差异为 0.0%（95% CI -0.5-0.4%）；非甾体抗炎药组风险差异为 -0.2%（95% CI -0.5-0.2%））。不过，联合用药组的院内并发症风险明显低于对乙酰氨基酚组（风险差异为-1.9%（95% CI -3.2至-0.6%）），深静脉血栓风险也明显低于对乙酰氨基酚组（风险差异为-1.4%（95% CI -2.2至-0.7%））。此外，非甾体抗炎药组的住院总费用高于对乙酰氨基酚组（差异为 438 美元（95% CI 249 至 630）；P < 0.001）。三组患者的其他次要结果无明显差异：结论：对乙酰氨基酚与非甾体抗炎药联用似乎是安全的，而且在减少院内并发症方面具有优势。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Bone & Joint Journal ORTHOPEDICS-SURGERY

CiteScore

9.40

自引率

10.90%

发文量

318

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