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Do Nonsteroidal Anti-Inflammatory or COX-2 Inhibitor Drugs Increase the Nonunion or Delayed Union Rates After Fracture Surgery? A Propensity-Score-Matched Study

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Abstract
Background: The effects of nonsteroidal anti-inflammatory drugs (NSAIDs)/cyclooxygenase (COX)-2 inhibitors on postoperative fracture-healing are controversial. Thus, we investigated the association between NSAID/COX-2 inhibitor administration and postoperative nonunion or delayed union of fractures. We aimed to determine the effects of NSAID/COX-2 inhibitor administration on postoperative fracture-healing with use of a common data model. Methods: Patients who underwent operative treatment of a fracture between 1998 and 2018 were included. To determine the effects of NSAID/COX-2 inhibitor administration on fracture-healing, postoperative NSAID/COX-2 inhibitor users were compared and 1:1 matched to nonusers, with 3,264 patients matched. The effect of each agent on bone-healing was determined on the basis of the primary outcome (nonunion/delayed union), defined as having a diagnosis code for nonunion or delayed union >= 6 months after surgery. The secondary outcome was reoperation for nonunion/delayed union. To examine the effect of NSAIDs/COX-2 inhibitors on bone union according to medication duration, a Kaplan-Meier survival analysis was performed. Results: Of the 8,693 patients who were included in the analysis, 208 had nonunion (178 patients; 2.05%) or delayed union (30 patients; 0.35%). Sixty-four (30.8%) of those 208 patients had a reoperation for nonunion or delayed union. NSAID users showed a significantly lower hazard of nonunion compared with the matched cohort of nonusers (hazard ratio, 0.69 [95% confidence interval, 0.48 to 0.98]; p = 0.040) but did not show a significant difference in the other matched comparison for any other outcomes. Kaplan-Meier survival analysis revealed significantly lower and higher nonunion/delayed union rates when the medication durations were <= 3 and >3 weeks, respectively (p = 0.001). For COX-2 inhibitors, the survival curve according to the medication duration showed no significant difference among the groups (p = 0.9). Conclusions: Our study demonstrated no short-term impact of NSAIDs/COX-2 inhibitors on long-bone fracture-healing. However, continued use of these medications for a period of >3 weeks may be associated with higher rates of nonunion or delayed union.
Author(s)
김효준김도훈김동민Erica Kholinne이의섭Wael Mohammed Alzahrani김지완전인호고경환
Issued Date
2021
Type
Article
Keyword
Abridged Index Medicus
DOI
10.2106/JBJS.20.01663
URI
https://oak.ulsan.ac.kr/handle/2021.oak/8675
https://ulsan-primo.hosted.exlibrisgroup.com/primo-explore/fulldisplay?docid=TN_cdi_proquest_miscellaneous_2539526868&amp;context=PC&amp;vid=ULSAN&amp;lang=ko_KR&amp;search_scope=default_scope&amp;adaptor=primo_central_multiple_fe&amp;tab=default_tab&amp;query=any,contains,Do%20Nonsteroidal%20Anti-Inflammatory%20or%20COX-2%20Inhibitor%20Drugs%20Increase%20the%20Nonunion%20or%20Delayed%20Union%20Rates%20After%20Fracture%20Surgery%3F%20A%20Propensity-Score-Matched%20Study&amp;offset=0&amp;pcAvailability=true
Publisher
JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME
Location
미국
Language
한국어
ISSN
0021-9355
Citation Volume
103
Citation Number
15
Citation Start Page
1402
Citation End Page
1410
Appears in Collections:
Medicine > Medicine
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