Ana Johnson1, Brian Milne2, Narges Jamali3, Matthew Pasquali3,4, Ian Gilron2, Steve Mann5, 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, Kingston Health Sciences Centre, Queen's University, 76 Stuart Street, Kingston, ON, K7L 2V7, 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, Toronto, ON, Canada. 8. Department of Anesthesiology and Perioperative Medicine, Kingston Health Sciences Centre, Queen's University, 76 Stuart Street, Kingston, ON, K7L 2V7, Canada. parlowj@queensu.ca.
Abstract
PURPOSE: Postoperative opioid use may be associated with increased healthcare utilization and costs. We sought to examine the relationship between duration of postoperative opioid prescriptions and healthcare costs and resource utilization in senior patients following hip and knee replacement. METHODS: We conducted a historical cohort study evaluating postoperative opioid use and healthcare costs in patients over the age of 65 yr undergoing primary total hip or knee arthroplasty over a ten-year period from 1 April 2006 to 31 March 2016. The last follow-up date was 31 March 2017. We identified preoperative and postoperative opioid prescriptions, patient characteristics, and healthcare costs using deidentified Ontario administrative databases (Institute of Clinical Evaluative Sciences). Duration of postoperative opioid use was divided into four categories: short-term (1-90 days), prolonged (91-180 days), chronic (181-365 days), and undocumented. RESULTS: The study included 49,638 hip and 85,558 knee replacement patients. Although the initial hospitalization accounted for the greatest cost in all patients, over the following year patients in the short-term opioid use group incurred the lowest average costs, and those in the chronic group incurred the highest (hip, CAD 17,528 vs CAD 26,736; knee, CAD 16,043 vs CAD 23,007), driven by increased healthcare resource utilization. CONCLUSION: Chronic opioid use after arthroplasty was associated with higher resource utilization and healthcare costs during the year following surgery. These results can be used to develop predictors of longer opioid use and higher costs. Further research is planned to determine whether recently implemented opioid reduction strategies can reduce healthcare resource utilization.
PURPOSE: Postoperative opioid use may be associated with increased healthcare utilization and costs. We sought to examine the relationship between duration of postoperative opioid prescriptions and healthcare costs and resource utilization in senior patients following hip and knee replacement. METHODS: We conducted a historical cohort study evaluating postoperative opioid use and healthcare costs in patients over the age of 65 yr undergoing primary total hip or knee arthroplasty over a ten-year period from 1 April 2006 to 31 March 2016. The last follow-up date was 31 March 2017. We identified preoperative and postoperative opioid prescriptions, patient characteristics, and healthcare costs using deidentified Ontario administrative databases (Institute of Clinical Evaluative Sciences). Duration of postoperative opioid use was divided into four categories: short-term (1-90 days), prolonged (91-180 days), chronic (181-365 days), and undocumented. RESULTS: The study included 49,638 hip and 85,558 knee replacement patients. Although the initial hospitalization accounted for the greatest cost in all patients, over the following year patients in the short-term opioid use group incurred the lowest average costs, and those in the chronic group incurred the highest (hip, CAD 17,528 vs CAD 26,736; knee, CAD 16,043 vs CAD 23,007), driven by increased healthcare resource utilization. CONCLUSION: Chronic opioid use after arthroplasty was associated with higher resource utilization and healthcare costs during the year following surgery. These results can be used to develop predictors of longer opioid use and higher costs. Further research is planned to determine whether recently implemented opioid reduction strategies can reduce healthcare resource utilization.
Authors: Ana Johnson; Brian Milne; Matthew Pasquali; Narges Jamali; Steve Mann; Ian Gilron; Kieran Moore; Erin Graves; Joel Parlow Journal: Can J Anaesth Date: 2021-08-25 Impact factor: 6.713
Authors: Amy Wesolowski; Aimee R Taylor; Hsiao-Han Chang; Robert Verity; Sofonias Tessema; Jeffrey A Bailey; T Alex Perkins; Daniel E Neafsey; Bryan Greenhouse; Caroline O Buckee Journal: BMC Med Date: 2018-12-28 Impact factor: 8.775