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Abstract：
BACKGROUND: Managing medication use in older orthopedic patients is imperative to extend their healthy life expectancy in an aging society. However, the actual situation regarding polypharmacy, the intake of potentially inappropriate medications (PIMs), and fall risk-increasing drugs (FRIDs) among older orthopedic patients is not well characterized. This study aimed to investigate the medication-based profiles of older orthopedic patients to highlight the critical points of concern.
METHODS: We retrospectively reviewed the clinical data of consecutive patients aged ≥ 65 years who underwent orthopedic surgery at two acute care hospitals between April 2020 and March 2021. The cutoff number of prescribed drugs for polypharmacy was set at 6. According to the specified guidelines, 19 categories of drugs were identified as PIMs, and 10 categories were classified as FRIDs.
RESULTS: A total of 995 older patients with orthopedic surgery were assessed, of which 57.4% were diagnosed with polypharmacy, 66.0% were receiving PIMs, and 41.7% were receiving FRIDs. The prevalence of FRID intake did not significantly differ among patients with degenerative spinal disease (n = 316), degenerative disease of extremities (n = 331), and fractures (n = 272). Compared with patients with degenerative disease of the extremities, the multivariable-adjusted prevalence ratios (PRs) of polypharmacy and PIM intake were significantly higher in patients with degenerative spinal disease (1.26 [confidence intervals (CI): 1.11-1.44] and 1.12 [CI: 1.00-1.25]), respectively. Use of antiemetic drugs (adjusted PR, 13.36; 95% CI: 3.14-56.81) and nonsteroidal anti-inflammatory drugs (adjusted PR, 1.37; 95% CI: 1.05-1.78) was significantly higher in patients with degenerative spinal disease. Among patients with degenerative spinal disease, the prevalence of antiemetic drug intake was 8.7% in lumbar spinal patients and 0% in cervical spinal patients.
CONCLUSIONS: More than half of the orthopedic patients in this study were affected by polypharmacy, and approximately two-thirds were prescribed some form of PIMs. Patients with degenerative spinal disease showed a significantly higher prevalence of polypharmacy and PIM use compared with other orthopedic diseases. Particular attention should be paid to the high frequency of antiemetic drugs and nonsteroidal anti-inflammatory drugs intake among patients with degenerative lumbar spine conditions.
METHODS: We retrospectively reviewed the clinical data of consecutive patients aged ≥ 65 years who underwent orthopedic surgery at two acute care hospitals between April 2020 and March 2021. The cutoff number of prescribed drugs for polypharmacy was set at 6. According to the specified guidelines, 19 categories of drugs were identified as PIMs, and 10 categories were classified as FRIDs.
RESULTS: A total of 995 older patients with orthopedic surgery were assessed, of which 57.4% were diagnosed with polypharmacy, 66.0% were receiving PIMs, and 41.7% were receiving FRIDs. The prevalence of FRID intake did not significantly differ among patients with degenerative spinal disease (n = 316), degenerative disease of extremities (n = 331), and fractures (n = 272). Compared with patients with degenerative disease of the extremities, the multivariable-adjusted prevalence ratios (PRs) of polypharmacy and PIM intake were significantly higher in patients with degenerative spinal disease (1.26 [confidence intervals (CI): 1.11-1.44] and 1.12 [CI: 1.00-1.25]), respectively. Use of antiemetic drugs (adjusted PR, 13.36; 95% CI: 3.14-56.81) and nonsteroidal anti-inflammatory drugs (adjusted PR, 1.37; 95% CI: 1.05-1.78) was significantly higher in patients with degenerative spinal disease. Among patients with degenerative spinal disease, the prevalence of antiemetic drug intake was 8.7% in lumbar spinal patients and 0% in cervical spinal patients.
CONCLUSIONS: More than half of the orthopedic patients in this study were affected by polypharmacy, and approximately two-thirds were prescribed some form of PIMs. Patients with degenerative spinal disease showed a significantly higher prevalence of polypharmacy and PIM use compared with other orthopedic diseases. Particular attention should be paid to the high frequency of antiemetic drugs and nonsteroidal anti-inflammatory drugs intake among patients with degenerative lumbar spine conditions.
摘要：
背景：在老龄化社会中，管理老年骨科患者的药物使用对于延长他们的健康预期寿命至关重要。然而,关于复方制剂的实际情况，摄入潜在的不适当药物(PIMs)，老年骨科患者的跌倒风险增加药物（FRID）的特征不明确。这项研究旨在调查老年骨科患者的药物治疗概况，以突出关注的关键点。
方法：我们回顾性回顾了2020年4月至2021年3月在两家急诊医院接受骨科手术的年龄≥65岁的连续患者的临床资料。多重用药的处方药的截止数量设定为6。根据指定的指导方针，19种药物被确定为PIMs，和10个类别被归类为FRID。
结果：共评估了995名骨科手术的老年患者，其中57.4%被诊断为多重用药，66.0%的人接受了PIMs，41.7%的人接受FRID。在患有退行性脊柱疾病的患者中，FRID摄入的患病率没有显着差异（n=316），四肢退行性疾病（n=331），和骨折（n=272）。与四肢退行性疾病患者相比，在退行性脊柱疾病患者中，多重用药和PIM摄入量的多变量校正患病率（PR）明显更高（1.26[置信区间（CI）：1.11-1.44]和1.12[CI：1.00-1.25]），分别。使用止吐药(调整后的PR，13.36；95%CI：3.14-56.81）和非甾体抗炎药（调整后的PR，1.37；95%CI：1.05-1.78）显著高于退行性脊柱疾病患者。在患有退行性脊柱疾病的患者中，腰椎患者服用止吐药的患病率为8.7%，颈椎患者为0%。
结论：本研究中超过一半的骨科患者受到多重用药的影响，与其他骨科疾病相比，大约三分之二的患者服用了某种形式的PIM。患有退行性脊柱疾病的患者显示出更高的多药和PIM使用率。在腰椎退行性疾病患者中，应特别注意止吐药和非甾体抗炎药的摄入频率较高。
方法：我们回顾性回顾了2020年4月至2021年3月在两家急诊医院接受骨科手术的年龄≥65岁的连续患者的临床资料。多重用药的处方药的截止数量设定为6。根据指定的指导方针，19种药物被确定为PIMs，和10个类别被归类为FRID。
结果：共评估了995名骨科手术的老年患者，其中57.4%被诊断为多重用药，66.0%的人接受了PIMs，41.7%的人接受FRID。在患有退行性脊柱疾病的患者中，FRID摄入的患病率没有显着差异（n=316），四肢退行性疾病（n=331），和骨折（n=272）。与四肢退行性疾病患者相比，在退行性脊柱疾病患者中，多重用药和PIM摄入量的多变量校正患病率（PR）明显更高（1.26[置信区间（CI）：1.11-1.44]和1.12[CI：1.00-1.25]），分别。使用止吐药(调整后的PR，13.36；95%CI：3.14-56.81）和非甾体抗炎药（调整后的PR，1.37；95%CI：1.05-1.78）显著高于退行性脊柱疾病患者。在患有退行性脊柱疾病的患者中，腰椎患者服用止吐药的患病率为8.7%，颈椎患者为0%。
结论：本研究中超过一半的骨科患者受到多重用药的影响，与其他骨科疾病相比，大约三分之二的患者服用了某种形式的PIM。患有退行性脊柱疾病的患者显示出更高的多药和PIM使用率。在腰椎退行性疾病患者中，应特别注意止吐药和非甾体抗炎药的摄入频率较高。
