Association between early mobilization after hip fracture surgery and risk of long-term opioid therapy
Yasmina Maria Tudorache1, Ina Trolle Andersen1, Thomas J Hjelholt2
1Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University Hospital, Aarhus University, Olof Palmes Alle 43-45, 8200 Aarhus N, Aarhus, Denmark.
Aim:
To examine the association between early mobilization after hip fracture surgery and the risk of long-term opioid therapy at 1-year follow-up.
Findings:
Long-term opioid therapy is a common complication after hip fracture surgery. Mobilization within 24 h after surgery is associated with a lower risk of long-term opioid therapy compared to mobilization between 24 and 36 h.
Message:
Early mobilization is one of the key elements of the successful patient recovery for reducing risk of complications and mortality after hip fracture surgery.
Purpose:
Early mobilization after hip fracture operation is associated with better clinical outcomes, but its impact on long-term opioid therapy (LTOT) remains unclear.
Methods:
Using Danish population-based registries we included patients aged ≥ 65 who underwent surgery for a first-time hip fracture between 2016 and 2021 (n = 36,229). LTOT was defined as redeeming ≥ 2 prescriptions between 31 and 365 days of surgery. Using stabilized inverse probability of treatment (sIPT) weighing, we calculated risks and risk differences with 95% confidence intervals (CI) for opioid use balancing mobilization groups ≤ 24 h vs 24-36 h on measured confounders and taking death into consideration.
Results:
67.3% of all patients were women and the median age was 82.6 years (75.8; 88.6). 75% of patients were mobilized ≤ 24 h of surgery, whereas 8% were mobilized between 24 and 36 h, 4.9% > 36 h, and 12.1% had missing data on mobilization. Patients mobilized ≤ 24 h and 24-36 h were similar in age, fracture type, and marital status, but those mobilized ≤ 24 h had fewer comorbidities, better pre-fracture mobility, and a higher social position. They also had a lower risk of LTOT (29.99%) compared to those mobilized 24-36 h (33.42%), with a weighted risk difference of 3.44% (95% CI 1.58-5.30).
Conclusions:
LTOT is common after hip fracture surgery. Mobilization ≤ 24 h after surgery is associated with a lower risk of LTOT compared to mobilization between 24 and 36 h. Early mobilization is one of the key elements of successful patient recovery for reducing complications and mortality after hip fracture surgery.
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