Home and Community Care Digest

Home and Community Care Digest September 2004 : 0-0

Untreated pain prolongs and complicates recovery from hip fracture surgery

Abstract

Many physicians are reluctant to prescribe post-operative opioid-based analgesics to older patients for fear of side effects such as constipation, nausea, delirium, sedation and nausea. Inadequately treated post-operative pain may have a greater impact on post-surgical outcomes in older patients. The purpose of this study was to identify the impact of pain on outcomes following hip fracture surgery in older adults. This study found that improved post-operative pain control is crucial for decreasing length of hospital stay, enhancing functional recovery, and improving long-term functional outcomes for older patients following hip fracture surgery.
Background: Undertreatment of post-operative pain is a persistent problem. Many physicians are reluctant to prescribe post-operative opioid-based analgesics to older patients for fear of precipitating side effects such as constipation, nausea, delirium, sedation and nausea. Inadequately treated postoperative pain may have a greater impact on post-surgical outcomes in older patients. The purpose of this study was to identify the impact of pain on outcomes following hip fracture surgery in older adults.

Method: Four hundred and eleven consecutive geriatric patients admitted for hip fracture at four New York hospitals were enrolled in this prospective cohort study. Patients' pain was assessed using standard measures along with other patient outcomes at immediately after surgery (duration of stay, physical therapy missed or shortened, ambulation, post-operative complications) and 6 months after hip fracture (outcomes: locomotion, mortality, return to the community, residual pain). The association between pain and these outcomes was examined via standard statistical techniques.

Findings: Patients who reported higher pain scores at rest (a) had longer hospital stays, (b) were more likely to miss or shorten physical therapy sessions, (c) were less likely to be ambulating at postoperative day 3, (d) took longer to ambulate more than getting to a bedside chair and (e) had less locomotion at 6 months than those who reported less pain. Pain at rest was not associated with postoperative complications, nursing home placement in the community, or survival or residual pain at 6 months. Post-operative pain was associated with increased length of stay, delayed ambulation, and long-term functional impairment.

Conclusions: These data suggest that improved post-operative pain control is crucial for decreasing length of hospital stay, enhancing functional recovery, and improving long-term functional outcomes for elderly patients following hip fracture surgery.

Reference: Morrison RS, Magaziner J, McLaughlin AM, Orosz G, Silberzweig SB, Koval KJ, Siu AL. "The impact of post-operative pain on outcomes following hip fracture". Pain 2003; 103: 303-311.

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