Jennifer Bethell1,2,3,4, Mark D Neuman5,6,7,8, Brian T Bateman9,10, Andrea D Hill1,11, Karim S Ladha3,12,13,14, Duminda N Wijeysundera2,3,12,13,14, Hannah Wunsch1,2,3,11,13,15. 1. Sunnybrook Research Institute, Toronto, Ontario, Canada. 2. ICES, Toronto, Ontario, Canada. 3. Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. 4. Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada. 5. Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania. 6. Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania. 7. Center for Perioperative Outcomes Research and Transformation, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania. 8. Center for Pharmacoepidemiology Research and Training, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania. 9. Department of Anesthesia, Perioperative, and Pain Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts. 10. Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts. 11. Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. 12. Department of Anesthesia, St. Michael's Hospital, Toronto, Ontario, Canada. 13. Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada. 14. Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada. 15. Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada.
Abstract
PURPOSE: Opioids are commonly prescribed for acute pain after surgery. However, it is unclear whether these prescriptions are usually modified to account for patient age and, in particular, opioid-related risks among older adults. We therefore sought to describe postoperative opioid prescriptions filled by opioid-naïve adults undergoing four common surgical procedures. METHODS: This retrospective cohort study used individually linked surgery and prescription opioid dispensing data from Ontario, Canada to create a population-based sample of 135 659 opioid-naïve adults who underwent one of four surgical procedures (laparoscopic cholecystectomy, laparoscopic appendectomy, knee meniscectomy, or breast excision) between 2013 and 2017. Patient age, in years, was categorized as 18 to 64, 65 to 69, 70 to 74, and 75 and over. Postoperative opioid prescriptions were identified as those filled on or within 6 days of surgical discharge date. For those who filled a prescription, we assessed the total morphine milligram equivalent (MME) dose, types of opioids, and any subsequent opioid prescriptions filled within 30 days of surgical discharge date. Results were presented stratified by surgical procedure. RESULTS: For three of the four surgical procedures we assessed, the proportion of patients who filled a postoperative opioid prescription decreased with age (P < 0.001 for trend), and there was a small shift in the type of opioid (more codeine or tramadol and less oxycodone; P < 0.001 for trend). However, the total MME dose of the initial prescription(s) filled showed minimal age-related trends. CONCLUSIONS: The proportion of opioid-naïve patients filling postoperative opioid prescriptions decreases with age. However, postoperative opioid prescription dosage is not typically different in older adults.
PURPOSE: Opioids are commonly prescribed for acute pain after surgery. However, it is unclear whether these prescriptions are usually modified to account for patientage and, in particular, opioid-related risks among older adults. We therefore sought to describe postoperative opioid prescriptions filled by opioid-naïve adults undergoing four common surgical procedures. METHODS: This retrospective cohort study used individually linked surgery and prescription opioid dispensing data from Ontario, Canada to create a population-based sample of 135 659 opioid-naïve adults who underwent one of four surgical procedures (laparoscopic cholecystectomy, laparoscopic appendectomy, knee meniscectomy, or breast excision) between 2013 and 2017. Patientage, in years, was categorized as 18 to 64, 65 to 69, 70 to 74, and 75 and over. Postoperative opioid prescriptions were identified as those filled on or within 6 days of surgical discharge date. For those who filled a prescription, we assessed the total morphine milligram equivalent (MME) dose, types of opioids, and any subsequent opioid prescriptions filled within 30 days of surgical discharge date. Results were presented stratified by surgical procedure. RESULTS: For three of the four surgical procedures we assessed, the proportion of patients who filled a postoperative opioid prescription decreased with age (P < 0.001 for trend), and there was a small shift in the type of opioid (more codeine or tramadol and less oxycodone; P < 0.001 for trend). However, the total MME dose of the initial prescription(s) filled showed minimal age-related trends. CONCLUSIONS: The proportion of opioid-naïve patients filling postoperative opioid prescriptions decreases with age. However, postoperative opioid prescription dosage is not typically different in older adults.
Authors: Karim S Ladha; Mark D Neuman; Gabriella Broms; Jennifer Bethell; Brian T Bateman; Duminda N Wijeysundera; Max Bell; Linn Hallqvist; Tobias Svensson; Craig W Newcomb; Colleen M Brensinger; Lakisha J Gaskins; Hannah Wunsch Journal: JAMA Netw Open Date: 2019-09-04
Authors: Sachin V Pasricha; Mina Tadrous; Wayne Khuu; David N Juurlink; Muhammad M Mamdani; J Michael Paterson; Tara Gomes Journal: Pain Date: 2018-08 Impact factor: 7.926