Older Patients Are at Risk of Prolonged Opioid Use After Hip Fracture Surgery

    Although numerous studies have analyzed opioid dependence in younger patient cohorts, relatively few have examined risk factors and prevalence associated with long-term opioid usage in patients aged 60 and older. Short-term risks, such as oversedation and delirium, have typically been of greater concern in these older patients.

    A new study from Kaiser Permanente demonstrates that postoperative opioid dependence is a risk no matter the patient’s age: In a retrospective cohort study, they found a notable risk of prolonged opioid use in older, opioid-naïve patients following hip fracture surgery.

    Their findings were presented at the 2021 Annual Meeting of the American Academy of Orthopaedic Surgeons.

    Utilizing Kaiser Permanente’s Hip Fracture Registry, the researchers identified 29,618 patients aged 60 and older who had undergone surgical treatment for hip fracture between 2009 and 2018 and who had not filled an opioid prescription in the 3 months prior to the hip fracture. Because the registry uses electronic medical records, the researchers were also able to capture relevant patient factors, such as demographics; pre-existing comorbidities; and opioid use before, during, and after surgery.

    With these data, the researchers examined outpatient opioid use during 3 time periods — 0 to 30 days post-surgery (P1), 31 to 90 days post-surgery (P2), and 91 to 180 days post-surgery (P3) — to analyze prolonged outpatient opioid use, defined as filling 1 or more opioid prescriptions in all 3 time periods.

    “Hip fractures stand alone not only in their frequency among older adults, but also because they increase the risk of morbidity and mortality,” said Kanu M. Okike, MD, MPH, lead researcher and orthopaedic trauma surgeon at Hawaii Permanente Medical Group in Honolulu.

    “Given that hip fractures are a severe injury in an already frail patient population, it would be problematic if some patients were also developing opioid dependence following their injury.”

    Of the patients who remained alive during the study period, the proportion of outpatient opioid usage was 83.7% (24,776/29,618) in P1, 69% (19,380/28,068) in P2, and 16.7% (4,435/26,481) in P3. Of note, the researchers found that that 1 in 6 older hip fracture patients were still taking opioid pain medications at 3 to 6 months following hip fracture surgery.

    Additional findings include the following:

    • Prolonged opioid usage was less commonly observed among patients who were either Asian, had an annual income of $150,000 or greater, or had undergone surgery with regional anesthesia.
    • The most common types of opioid prescriptions filled in the 6 months following hip fracture surgery were hydrocodone (53.9%), oxycodone (22.4%), and morphine (6.8%).
    • Prolonged opioid usage was more common following fracture fixation and less common following total hip arthroplasty (both in comparison to hemiarthroplasty).

    While most of the concerns and opioid usage research in elderly individuals have centered on short-term risks, such as oversedation and delirium, our findings suggest that prolonged opioid usage is an important concern in this older population, just as in the younger trauma populations,” said Dr. Okike.

    “Our hope is that by uncovering more data and continuing to educate patients of all ages, the orthopaedic community will be able to better aid efforts to decrease long-term opioid dependence in their patients.”


    Okike KM, Chang RN, Chan PH, Paxton L, Prentice HA. Prolonged Opioid Usage Following Hip Fracture Surgery in Opioid-Naïve Older Patients (Paper 658). Presented at the 2021 Annual Meeting of the American Academy of Orthopaedic Surgeons, August 31-September 3, San Diego, California.