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- Al Dabbagh, Zewar, et al.
(author)
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No signs of dose escalations of potent opioids prescribed after tibial shaft fractures : a study of Swedish National Registries
- 2014
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In: BMC Anesthesiology. - London : BioMed Central. - 1471-2253 .- 1471-2253. ; 14, s. 4-
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Journal article (peer-reviewed)abstract
- Background: The pattern of opioid use after skeletal trauma is a neglected topic in pain medicine. The purpose of this study was to analyse the long-term prescriptions of potent opioids among patients with tibial shaft fractures.Methods: Data were extracted from the Swedish National Hospital Discharge Register, the National Pharmacy Register, and the Total Population Register, and analysed accordingly. The study period was 2005-2008.Results: We identified 2,571 patients with isolated tibial shaft fractures. Of these, 639 (25%) collected a prescription for opioids after the fracture. The median follow-up time was 17 (interquartile range [IQR] 7-27) months. Most patients with opioid prescriptions after fracture were male (61%) and the median age was 45 (16-97) years. The leading mechanism of injury was fall on the same level (41%). At 6 and 12 months after fracture, 21% (95% CI 17-24) and 14% (11-17) were still being treated with opioids. Multiple Cox regression-analysis (adjusted for age, sex, type of treatment, and mechanism of injury) revealed that older patients (age >50 years) were more likely to end opioid prescriptions (Hazard ratio 1.5 [95% CI 1.3-1.9]). During follow-up, the frequency of patients on moderate and high doses declined. Comparison of the daily morphine equivalent dose among individuals who both had prescriptions during the first 3 months and the 6th month indicated that the majority of these patients (11/14) did not have dose escalations.Conclusions: We did not see any signs in registry-data of major dose escalations over time in patients on potent opioids after tibial shaft fractures.
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| 2. |
- Al Dabbagh, Zewar
(author)
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Patients with femoral and tibial shaft fractures : aspects on epidemiology and pain therapy
- 2018
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Doctoral thesis (other academic/artistic)abstract
- Background: Fractures of the tibial and femoral shafts are common injuries with outcomes depending on injury mechanism, fracture pattern, patient-specific data and treatment methods. Nationwide epidemiological data on these often serious injuries are sparse. Information on long-term therapy with opioids in these patients is lacking in the literature. Therefore, the aim of the present thesis was to study the incidence, mechanism of injury and treatment methods of patients with tibial and femoral shaft fractures. Soft tissue reconstructions and amputations after open tibial fractures in Sweden were also analyzed. Moreover, the long-term pattern of opioid prescriptions in patients after tibial and femoral shaft fractures was examined on a nationwide basis. Patients and methods : Data on all hospital admissions for tibial and femoral shaft fractures during 1998-2004 (study I-II) and for open tibial fractures during 1998-2010 (study III) were extracted from the Swedish National Hospital Discharge Register. Incidence rates (IR) per 100,000 person-years (pyr), mechanisms of injury, surgical interventions and amputation rates were analyzed. The Swedish Prescribed Drug Register was used to extract data on long-term opioid prescriptions for patients sustaining tibial (study IV) and femoral (study V) shaft fractures during 2005-2008. Age- and sex-matched control groups without the index fracture were gathered from the Total Population Register for comparisons. Results : Study I. 10,627 admissions for tibial shaft fractures corresponding to an annual IR of 17/100,000 pyr were identified. The number of hospital admissions declined by 12% during the study period with more reduction in male incidence. Most admissions were found in the age-groups 10-19 years in males and 50-59 years in females. Study II. 6,409 admissions for femoral shaft fractures were identified corresponding to an annual IR of 10/100,000 pyr. The total number of hospital admissions remained stable during 1998-2004. Most admissions were generated by females in the 80-89 years age-group and by males under the age of 10 years. Study III. Of 3,777 patients with open tibial fractures, 9% underwent soft tissue reconstructive surgery. The overall rate of amputation was 3.6%. The risk of amputation according to an adjusted analysis was increased in patients older than 70 years (OR 2.7) and in patients who underwent soft-tissue reconstructions (OR 3.1). Study IV. A total of 2,571 patients with isolated tibial shaft fractures were identified, of whom 25% filled prescriptions of strong opioids after the fracture. An adjusted analysis revealed that older patients (>=50 years) were more likely to end opioid prescriptions (HR 1.5). At six, 12 and 18 months after the fracture, 21%, 14% and 11% of the patients respectively, were still getting prescribed opioids. Study V. A total of 1,471 patients with isolated femoral shaft fractures were identified, of whom 61% received prescriptions of opioids (strong and/or weak) during a median follow-up of 20 months. In the age- and sex-matched control cohort without fracture (7,339 individuals), 25% had opioid prescriptions dispensed during the same period. Conclusions: Nationwide epidemiological data on patients with tibial and femoral shaft fractures can be used by healthcare providers to plan hospital beds, surgical interventions, risk preventions and centralization of more complicated injuries. The amputation rate after open tibial fractures is low. The risk of amputation is increased in older patients and if the reconstruction is delayed beyond 72 hours. A notable proportion of patients continue to receive prescribed opioids several months after femoral and tibial fractures. However, the risk of dose escalations seems to be small.
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| 3. |
- Weiss, Rüdiger J., et al.
(author)
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Decreasing incidence of tibial shaft fractures between 1998 and 2004 : information based on 10,627 Swedish inpatients
- 2008
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In: Acta Orthopaedica. - Lund : Taylor & Francis. - 1745-3674 .- 1745-3682. ; 79:4, s. 526-533
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Journal article (peer-reviewed)abstract
- Background and purpose There is a lack of national epidemiological data on the characteristics of patients with tibial shaft fractures. We therefore analyzed data on Swedish patients with tibial shaft fractures in this nationwide population study based on data from 1998 through 2004. Methods Data on all patients with tibial shaft fractures were extracted from the Swedish National Hospital Discharge Register. Results We identified 10,627 hospital admissions for tibial shaft fractures, corresponding to an annual incidence rate of 17 per 100,000 person-years (pyr). The number of hospital admissions decreased by 12% during the period 1998-2004, mostly from a reduction in male incidence. The median (SD) age at admission was 28 (22) years for men and 51 (26) years for women. The two major mechanisms of injury were falls on the same level (48%) and transport accidents (21%). Surgical procedures were dominated by osteosynthesis with nail (48%), followed by closed reduction and plaster cast (27%), and external fixation (12%). 12% of all tibial shaft fractures were classified as open, corresponding to an incidence rate of 2.3 per 100,000 pyr, which declined during 1998-2004. Interpretation This nationwide study of tibial shaft fractures shows a falling off of fracture incidence, a finding that can be used to advantage by healthcare providers. In a recent review, the annual incidence of tibial shaft fractures was reported to be 22 per 100,000 inhabitants (Court-Brown and Caesar 2006). To date, rather few epidemiological studies have been undertaken to examine the incidence of this injury (Knowelden et al. 1964, Bengner et al. 1990, Donaldson et al. 1990, Court-Brown and McBirnie 1995, Emami et al. 1996, Singer et al. 1998, van Staa et al. 2001), and with varying results. Most of the earlier epidemiological studies were retrospective or case series from single hospitals, and prior to the present study no analyses on a nationwide basis had been undertaken.Basic epidemiological data on frequency and distribution, mechanisms of injury, surgical procedures, and on temporal variations are of importance in assisting the planning and delivery of healthcare. The purpose of this investigation was to provide an update on incidence, admissions, causes of fracture, and operation of these fractures on a nationwide basis in Sweden during the period 1998-2004.
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| 4. |
- Weiss, Rüdiger J., et al.
(author)
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National data of 6409 Swedish inpatients with femoral shaft fractures : stable incidence between 1998 and 2004
- 2009
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In: Injury. - : Elsevier BV. - 0020-1383 .- 1879-0267. ; 40:3, s. 304-308
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Journal article (peer-reviewed)abstract
- INTRODUCTION: Femoral shaft fractures are commonly thought to be primarily associated with high-energy trauma in young persons. Only limited attention has been given to low-energy violence as a cause of these fractures among the elderly. National epidemiological data on characteristics of patients with femoral shaft fractures are lacking, so the purpose of this study was to analyse the incidence, admissions, causes of fracture and operations for these fractures on a nationwide basis in Sweden during 1998-2004. PATIENTS AND METHODS: Data on all femoral shaft fractures were extracted from the Swedish National Hospital Discharge Registry. Sex- and age-specific fracture incidence, hospital admissions, mechanisms of injury and surgical procedures were analysed using descriptive analysis, linear-regression analysis and other methods as appropriate. RESULTS: Over a period of 7 years, 6409 patients with femoral shaft fractures were identified, corresponding to an annual incidence of 10 per 100,000 person-years. Men had a younger median age (27 years, IQR 12-68) than women (79 years, IQR 62-86) (p<0.001). Females (54%) generated more admissions than males (46%). The incident rate ratio between men and women was 0.9 (p<0.001). Most hospital admissions were generated among females by the 80-89 years age-group and among males <10 years of age. 2% of the fractures were open fractures. The total number of hospital admissions was stable during 1998-2004. The two major mechanisms of injury were falls on the same level (50%) and transport accidents (17%). A significant number of fractures occurred among elderly patients after low-energy trauma. Osteosynthesis with femoral nail (54%) was the preferred operation, followed by osteosynthesis with plate and screws (16%), skeletal traction (14%) and external fixation (6%). DISCUSSION: This nationwide study on femoral shaft fractures provides an update on incidence, admissions, external causes and surgical procedures. This information assists health-care providers in planning hospital beds, surgical interventions and risk preventions. Moreover, these data can be used for power calculations for further clinical studies.
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