Ana Johnson1, Brian Milne2, Matthew Pasquali3,4, Narges Jamali3, Steve Mann5, Ian Gilron2, Kieran Moore6, Erin Graves7, Joel Parlow8. 1. Department of Public Health Sciences, Senior ICES Scientist, Queen's University, Kingston, ON, Canada. 2. Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, ON, Canada. 3. Queen's University, Kingston, ON, Canada. 4. Western University, London, ON, Canada. 5. Division of Orthopedic Surgery, Queen's University, Kingston, ON, Canada. 6. Departments of Emergency and Family Medicine, Queen's University, Kingston, ON, Canada. 7. Institute for Clinical Evaluative Sciences, Sunnybrook Health Sciences Centre, Toronto, ON, Canada. 8. Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, ON, Canada. parlowj@queensu.ca.
Abstract
PURPOSE: Canadian seniors who undergo hip and knee arthroplasty often experience significant postoperative pain, which could result in persistent opioid use. We aimed to document the impact of preoperative opioid use and other characteristics on postoperative opioid prescriptions in elderly patients following hip and knee replacement before widespread dissemination of opioid reduction strategies. METHODS: We conducted a historical cohort study to evaluate postoperative opioid use in patients over 65 yr undergoing primary total hip and knee replacement over a ten-year period from 1 April 2006 to 31 March 2016, using linked de-identified Ontario administrative data. We determined the use of preoperative opioids and the duration of postoperative opioid prescriptions (short-term [1-90 days], prolonged [91-180 days], chronic [181-365 days], or undocumented). RESULTS: The study included 49,638 hip and 85,558 knee replacement patients. Eighteen percent of hip and 21% of knee replacement patients received an opioid prescription within 90 days before surgery. Postoperatively, 51% of patients filled opioid prescriptions for 1-90 days, while 24% of hip and 29% of knee replacement patients filled prescriptions between 6 and 12 months, with no impact of preoperative opioid use. Residence in long-term care was a significant predictor of chronic opioid use (hip: odds ratio [OR], 2.64; 95% confidence interval [CI], 1.93 to 3.59; knee: OR, 2.46; 95% CI, 1.75 to 3.45); other risk factors included female sex and increased comorbidities. CONCLUSION: Despite a main goal of joint arthroplasty being relief of pain, seniors commonly remained on postoperative opioids, even if not receiving opioids before surgery. Opioid reduction strategies need to be implemented at the surgical, primary physician, long-term care, and patient levels. These findings form a basis for future investigations following implementation of opioid reduction approaches.
PURPOSE: Canadian seniors who undergo hip and knee arthroplasty often experience significant postoperative pain, which could result in persistent opioid use. We aimed to document the impact of preoperative opioid use and other characteristics on postoperative opioid prescriptions in elderly patients following hip and knee replacement before widespread dissemination of opioid reduction strategies. METHODS: We conducted a historical cohort study to evaluate postoperative opioid use in patients over 65 yr undergoing primary total hip and knee replacement over a ten-year period from 1 April 2006 to 31 March 2016, using linked de-identified Ontario administrative data. We determined the use of preoperative opioids and the duration of postoperative opioid prescriptions (short-term [1-90 days], prolonged [91-180 days], chronic [181-365 days], or undocumented). RESULTS: The study included 49,638 hip and 85,558 knee replacement patients. Eighteen percent of hip and 21% of knee replacement patients received an opioid prescription within 90 days before surgery. Postoperatively, 51% of patients filled opioid prescriptions for 1-90 days, while 24% of hip and 29% of knee replacement patients filled prescriptions between 6 and 12 months, with no impact of preoperative opioid use. Residence in long-term care was a significant predictor of chronic opioid use (hip: odds ratio [OR], 2.64; 95% confidence interval [CI], 1.93 to 3.59; knee: OR, 2.46; 95% CI, 1.75 to 3.45); other risk factors included female sex and increased comorbidities. CONCLUSION: Despite a main goal of joint arthroplasty being relief of pain, seniors commonly remained on postoperative opioids, even if not receiving opioids before surgery. Opioid reduction strategies need to be implemented at the surgical, primary physician, long-term care, and patient levels. These findings form a basis for future investigations following implementation of opioid reduction approaches.
Authors: Lee A Fleisher; Joshua A Beckman; Kenneth A Brown; Hugh Calkins; Elliot L Chaikof; Kirsten E Fleischmann; William K Freeman; James B Froehlich; Edward K Kasper; Judy R Kersten; Barbara Riegel; John F Robb Journal: Circulation Date: 2009-11-02 Impact factor: 29.690
Authors: Cody C Wyles; Mario Hevesi; Daniel S Ubl; Elizabeth B Habermann; Halena M Gazelka; Robert T Trousdale; Norman S Turner; Mark W Pagnano; Tad M Mabry Journal: JB JS Open Access Date: 2020-03-03
Authors: Maria C S Inacio; Craig Hansen; Nicole L Pratt; Stephen E Graves; Elizabeth E Roughead Journal: BMJ Open Date: 2016-04-29 Impact factor: 2.692
Authors: Ana Johnson; Brian Milne; Narges Jamali; Matthew Pasquali; Ian Gilron; Steve Mann; Kieran Moore; Erin Graves; Joel Parlow Journal: Can J Anaesth Date: 2022-03-22 Impact factor: 6.713