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Farronato DM, Pezzulo JD, Juniewicz R, Rondon AJ, Cox RM, Davis DE. Effects of socioeconomic burden on opioid use following total shoulder arthroplasty. J Shoulder Elbow Surg 2024:S1058-2746(24)00406-3. [PMID: 38852706 DOI: 10.1016/j.jse.2024.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 04/08/2024] [Accepted: 04/11/2024] [Indexed: 06/11/2024]
Abstract
BACKGROUND Preoperative opioid users experience worse outcomes and higher complication rates compared to opioid-naïve patients following shoulder arthroplasty. This study evaluates the effects of socioeconomic status, as measured by the Distressed Communities Index (DCI), on pre- and postoperative opioid use and its influence on clinical outcomes such as readmission and revision surgery. METHODS A retrospective review of patients who underwent primary shoulder arthroplasty (Current Procedural Terminology code 23472) from 2014 to 2022 at a single academic institution was performed. Exclusion criteria included arthroplasty for fracture, active malignancy, and revision arthroplasty. Demographics, Charlson Comorbidity Index, DCI, and clinical outcomes including 90-day readmission and revision surgery were collected. Patients were classified according to the DCI score of their zip code. Using the Prescription Drug Monitoring Program database, patient pre- and postoperative opioid use in morphine milligram equivalents was gathered. RESULTS Individuals from distressed communities used more opioids within 90 days preoperatively compared to patients from prosperous, comfortable, mid-tier, and at-risk populations, respectively. Patients from distressed communities also used significantly more opioids within 90 days postoperatively compared with prosperous, comfortable, and mid-tier, respectively. Of patients from distressed communities, 35.1% developed prolonged opioid use (filling prescriptions >30 days after surgery), significantly more than all other cohorts. Among all patients, 3.5% were readmitted within 90 days and were more likely to be prolonged opioid users (38.9 vs. 21.3%, P < .001). Similarly, 1.5% of patients underwent revision surgery. Those who underwent revision were significantly more likely to be prolonged opioid users (38.2 vs. 21.7%, P = .002). CONCLUSIONS Shoulder arthroplasty patients from distressed communities use more opioids within 90 days before and after their surgery and are more likely to become prolonged opioid users, placing them at risk for readmission and revision surgery. Identifying patients at an increased risk for excess opioid use is essential to employ appropriate strategies that minimize the detrimental effects of prolonged use following surgery.
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Affiliation(s)
- Dominic M Farronato
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Joshua D Pezzulo
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Robert Juniewicz
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Alexander J Rondon
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Ryan M Cox
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Daniel E Davis
- Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, PA, USA.
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Klenø AS, Mechlenburg I, Gademan MGJ, Sørensen HT, Pedersen AB. Do sex, age, and comorbidities modify the association of socioeconomic status and opioid use after total hip arthroplasty?: a population-based study from the Danish Hip Arthroplasty Register. Acta Orthop 2024; 95:233-242. [PMID: 38757926 PMCID: PMC11100492 DOI: 10.2340/17453674.2024.40708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 04/26/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND AND PURPOSE We aimed to examine the association between socioeconomic status (SES) markers and opioid use after primary total hip arthroplasty (THA) due to osteoarthritis, and whether sex, age, or comorbidities modify any association. METHODS Using Danish databases, we included 80,038 patients undergoing primary THA (2001-2018). We calculated prevalences and prevalence ratios (PRs with 95% confidence intervals [CIs]) of immediate post-THA opioid use (≥ 1 prescription within 1 month) and continued opioid use (≥ 1 prescription in 1-12 months) among immediate opioid users. Exposures were individual-based education, cohabitation, and wealth. RESULTS The prevalence of immediate opioid use was ~45% in preoperative non-users and ~60% in preoperative users (≥ 1 opioid 0-6 months before THA). Among non-users, the prevalences and PRs of continued opioid use were: 28% for low vs. 21% for high education (PR 1.28, CI 1.20-1.37), 27% for living alone vs. 23% for cohabiting (PR 1.09, CI 1.04-1.15), and 30% for low vs. 20% for high wealth (PR 1.43, CI 1.35-1.51). Among users, prevalences were 67% for low vs. 55% for high education (1.22, CI 1.17-1.27), 68% for living alone vs. 60% for cohabiting (PR 1.10, CI 1.07-1.12), and 73% for low wealth vs. 54% for high wealth (PR 1.32, CI 1.28-1.36). Based on testing for interaction, sex, age, and comorbidity did not statistically significant modify the associations. Nevertheless, associations were stronger in younger patients for all SES markers (mainly for non-users). CONCLUSION Markers of low SES were associated with a higher prevalence of continued post-THA opioid use. Age modified the magnitude of the associations, but it was not statistically significant.
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Affiliation(s)
- André S Klenø
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Inger Mechlenburg
- Department of Orthopaedic Surgery, Department of Clinical Medicine, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
| | - Maaike G J Gademan
- Department of Orthopaedics, Department of Clinical Epidemiology, Leiden University Medical Center, the Netherlands
| | - Henrik T Sørensen
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Alma B Pedersen
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark.
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Genel F, Harris IA, Pavlovic N, Lewin A, Mittal R, Huang AY, Penm J, Patanwala AE, Brady B, Adie S, Naylor JM. Does preoperative opioid use predict outcomes to 6 months following primary unilateral knee or hip arthroplasty for osteoarthritis? A data-linked retrospective study. ARTHROPLASTY 2024; 6:11. [PMID: 38438888 PMCID: PMC10913630 DOI: 10.1186/s42836-024-00234-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 01/03/2024] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND Few Australian studies have examined the incidence of prescribed opioid use prior to primary total knee or total hip arthroplasty (TKA, THA) and whether it predicts post-surgery outcomes. A recent Australian study demonstrated that the prevalence of pre-arthroplasty opioid use was approximately 16%. In the United States, approximately 24% of people undergoing TKA or THA are chronic opioid users preoperatively. PURPOSE This study aimed to determine (i) the proportion of TKA and THA patients who use prescribed opioids regularly (daily) before surgery (i.e., opioid use reported between the time of waitlisting and any time up to 3 months before surgery), (ii) if opioid use before surgery predicts (a) complication/readmission rates to 6-months post-surgery, and (b) patient-reported outcomes to 6-months post-surgery. METHODS A retrospective cohort study of patients who underwent TKA or THA between January 2013 and June 2018 from two Australian public hospitals was undertaken utilizing linked individual patient-level data from two prospectively collected independent databases comprising approximately 3,500 and 9,500 people (database contained known opioid usage data within the 5-year time frame). Inclusion criteria included (i) primary diagnosis of osteoarthritis of the index joint, (ii) primary elective THA or TKA, and (iii) age ≥ 18 years. Exclusion criteria included (i) revision arthroplasty, (ii) non-elective arthroplasty, (iii) hip hemiarthroplasty, (iv) uni-compartmental knee arthroplasty, and (v) previous unilateral high tibial osteotomy. RESULTS Analysis was completed on 1,187 study participants (64% female, 69% TKA, mean (SD) age 67 [9.9]). 30% were using regular opioids preoperatively. Adjusted regression analyses controlling for multiple co-variates indicated no significant association between preoperative opioid use and complications/readmission rates or patient-reported outcomes to 6 months post-surgery. Model diagnostics produced poor discrimination for area under the curves and non-significant goodness of fit tests. Pre-arthroplasty opioid use was associated with lower health-related quality of life (EuroQol-Visual Analogue Scale) compared to non-opioid users undergoing primary THA (mean difference -5.04 [-9.87, -0.22], P = 0.04, Adjusted R2 = 0.06) CONCLUSION: In this study, 30% of patients were using prescribed opioids daily prior to primary TKA or THA. Pre-arthroplasty opioid use was not associated with postoperative adverse events or patient-reported pain, function, or global perceived improvement up to six months post-surgery.
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Affiliation(s)
- Furkan Genel
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Sydney, NSW, 2170, Australia.
- St. George and Sutherland Clinical School, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, 2217, Australia.
| | - Ian A Harris
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Sydney, NSW, 2170, Australia
- Liverpool Hospital, South Western Sydney Local Health District, Sydney, NSW, 2170, Australia
- South Western Sydney Clinical School, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, 2170, Australia
| | - Natalie Pavlovic
- South Western Sydney Clinical School, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, 2170, Australia
- Fairfield Hospital, South Western Sydney Local Health District, Sydney, NSW, 2176, Australia
| | - Adriane Lewin
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Sydney, NSW, 2170, Australia
- South Western Sydney Clinical School, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, 2170, Australia
| | - Rajat Mittal
- South Western Sydney Clinical School, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, 2170, Australia
| | - Andrew Y Huang
- Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC, 3010, Australia
| | - Jonathan Penm
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2050, Australia
- Department of Pharmacy, Prince of Wales Hospital and Community Health Services, Randwick, NSW, 2031, Australia
| | - Asad E Patanwala
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2050, Australia
- Department of Pharmacy, Royal Prince Alfred Hospital, Camperdown, NSW, 2050, Australia
| | - Bernadette Brady
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, 2050, Australia
- School of Health Sciences, Western Sydney University, Sydney, NSW, 2751, Australia
| | - Sam Adie
- St. George and Sutherland Clinical School, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, 2217, Australia
- St. George and Sutherland Centre for Clinical Orthopaedic Research, Kogarah, NSW, 2217, Australia
| | - Justine M Naylor
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Sydney, NSW, 2170, Australia
- South Western Sydney Clinical School, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, 2170, Australia
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Zeid BA, AlHoyeck M, Lahoud N. Consumption of Acetaminophen During Pregnancy: A Survey on Knowledge, Attitudes and Practices of Lebanese Women. Matern Child Health J 2024; 28:532-544. [PMID: 37943396 DOI: 10.1007/s10995-023-03817-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2023] [Indexed: 11/10/2023]
Abstract
OBJECTIVES Use of acetamoniphen (paracetamol or N-acetyl-para-aminophenol [APAP]) during pregnancy is considered safe; however certain practices have been related to the risk of developing neurodevelopmental disorders in offspring. Therefore, the present study aimed to assess women's knowledge, attitudes and practices (KAP) towards the use APAP during pregnancy and its associated factors. METHODS This cross-sectional study was conducted between May 15 and August 31, 2020, among pregnant Lebanese women and those who had given birth in the last 12 months. Online self-administered questionnaire was used for data collection. KAP were described and a knowledge score was generated. Multivariable linear models were used to test the association of participants' sociodemographic characteristics with their knowledge and practices related to the use of APAP. RESULTS Out of 305 participants, 72.8% had moderate knowledge about the use of APAP during pregnancy. Actually, more than 50% of them were unable to differentiate between APAP and other pain medications, determine the maximum recommended daily dose, specify the minimum time to wait between doses and identify potential effects of APAP on both mother and unborn child. A higher level of education was associated with a higher knowledge score (β = 2.32, 95%CI=[0.91; 3.73]; p = 0.001). Moreover, women had positive attitudes towards APAP use, perceiving a low risk of toxicity. Indeed, 70.5% of women used APAP at least once during their pregnancy, with 63.7% using it safely. Women with higher knowledge, experiencing at least five somatic symptoms and having a low socioeconomic level tended to be more APAP users (p < 0.05). CONCLUSIONS FOR PRACTICE Health professionals have the responsibility to give adequate and personalized advice to women regarding their medicines.
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Affiliation(s)
- Berthe Abi Zeid
- Faculty of Public Health, Lebanese University, Fanar, Lebanon.
- Center for Research on Population and Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
| | - Mary AlHoyeck
- Faculty of Public Health, Lebanese University, Fanar, Lebanon
| | - Nathalie Lahoud
- Faculty of Public Health, Lebanese University, Fanar, Lebanon
- National Institute of Public Health, Clinical Epidemiology & Toxicology (INSPECT-LB), Beirut, Lebanon
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Haaber RS, Iversen KG, Klenø AS, Stisen MB, Mechlenburg I, Pedersen AB. Multimorbidity measured with Charlson Comorbidity Index is not associated with clinically relevant risk of revision after primary total hip arthroplasty: a population-based cohort study on 98,647 patients from the Danish Hip Arthroplasty Register. Acta Orthop 2024; 95:1-7. [PMID: 38193361 PMCID: PMC10775175 DOI: 10.2340/17453674.2024.35225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 11/22/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND AND PURPOSE Evidence for guiding healthcare professionals on the risks of total hip arthroplasty (THA) in multimorbid patients is sparse. We aimed to examine the association between multimorbidity and the risk of revision due to any cause and specific causes after primary THA due to osteoarthritis. PATIENTS AND METHODS We identified 98,647 THA patients and subsequent revisions in the Danish Hip Arthroplasty Register from 1995 to 2018. Multimorbidity was measured with the Charlson Comorbidity Index (CCI). Using the CCI (low, medium, high), we calculated the cumulative incidence function (CIF) of first revision up to 10 years after THA. Adjusted cause-specific hazard ratios (aHRs) were estimated using Cox regressions. All estimates are presented with 95% confidence intervals (CI). RESULTS Overall, the prevalence of patients with low, medium, and high CCI was 70%, 24%, and 6%. The CIF of any revision within 10 years was 6.5% (CI 6.2-6.7) in low and 6.5% (CI 5.8-7.3) in high CCI, with an aHR of 1.4 (CI 1.2-1.6) for patients with high compared with low CCI. The corresponding aHRs for cause-specific revision were 1.3 (CI 1.0-1.6) for aseptic loosening within 10 years, 1.2 (CI 0.9-1.6) for infection, and 1.7 (CI 1.3-2.2) for dislocation, both within 2 years. CONCLUSION Multimorbidity is associated with a minor but not clinically relevant increased risk of revision up to 10 years after primary THA.
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Affiliation(s)
- Rikke S Haaber
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus; Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus.
| | - Katrine G Iversen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus; Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus
| | - André S Klenø
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus; Department of Clinical Medicine, Aarhus University, Aarhus
| | - Martin B Stisen
- Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus; Department of Clinical Medicine, Aarhus University, Aarhus
| | - Inger Mechlenburg
- Department of Orthopedic Surgery, Aarhus University Hospital, Aarhus; Department of Clinical Medicine, Aarhus University, Aarhus; Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Alma B Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus; Department of Clinical Medicine, Aarhus University, Aarhus
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Lind ANR, Jakobsen SKM, Klenø AS, Pedersen AB. Sex and age differences in the use of analgesic drugs before and after primary total hip arthroplasty in 105,520 Danish patients. Surgeon 2023; 21:381-389. [PMID: 37567845 DOI: 10.1016/j.surge.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 07/18/2023] [Accepted: 07/20/2023] [Indexed: 08/13/2023]
Abstract
BACKGROUND We examined analgesic drug use before and after total hip arthroplasty (THA) by sex and age, and impact of comorbidity in that context. METHODS Using Danish nationwide medical registries, we included 105,520 THA patients (1996-2018). We calculated prevalence of overall analgesic drug use and use of NSAIDs and opioids separately in four quarters before (-Q4 to -Q1) and after THA (Q1 to Q4). -Q4 and Q4 was compared using prevalence rate ratios (PRR) with 95% confidence interval (CI). RESULTS Among women, analgesic drug use was 46% in -Q4, 65% in Q1, but decreased to 31% in Q4 (PRR: 0.68 (CI: 0.67-0.69)). Among men, these numbers were 39% in -Q4, 62% in Q1, and 23% in Q4 (PRR: 0.61 (CI: 0.60-0.63)). Analgesic drug use was higher among older patients in all quarters except Q1. Analgesic drug use decreased from 40% in -Q4 to 25% in Q4 (PRR: 0.62 (CI: 0.59-0.64)) in patients <55 years, and from 44% to 30% in patients >85 years, (PRR: 0.67 (CI: 0.63-0.71)). Women used more NSAIDs and opioids than men. Older patients used more opioids compared to younger, while variation in NSAID use by age was small. Decrease in analgesic drug use from -Q4 to Q4 was least pronounced in patients with comorbidity history. CONCLUSIONS Women and older patients have higher prevalence of analgesic drug use before and after THA, and a smallest reduction in analgesic drug use from before to after THA. Comorbidity history modified these associations.
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Affiliation(s)
- Allice N R Lind
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Sophie K M Jakobsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - André S Klenø
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Alma B Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
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van Brug HE, Nelissen RGHH, Rosendaal FR, van Steenbergen LN, van Dorp ELA, Bouvy ML, Dahan A, Gademan MGJ. Out-of-hospital opioid prescriptions after knee and hip arthroplasty: prescribers and the first prescribed opioid. Br J Anaesth 2023; 130:459-467. [PMID: 36858887 DOI: 10.1016/j.bja.2022.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 12/14/2022] [Accepted: 12/28/2022] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND We determined the first prescribed opioid and the prescribers of opioids after knee and hip arthroplasty (KA/HA) between 2013 and 2018 in the Netherlands. We also evaluated whether the first prescribed opioid dose was associated with the total dispensed dose and long-term opioid use in the first postoperative year. METHODS The Dutch Foundation for Pharmaceutical Statistics was linked to the Dutch Arthroplasty Register. Stratified for KA/HA, the first out-of-hospital opioid within 30 days of operation was quantified as median morphine milligram equivalent (MME). Opioid prescribers were orthopaedic surgeons, general practitioners, rheumatologists, anaesthesiologists, and other physicians. Long-term use was defined as ≥1 opioid prescription for >90 postoperative days. We used linear and logistic regression analyses adjusted for confounders. RESULTS Seventy percent of 46 106 KAs and 51% of the 42 893 HAs were prescribed ≥1 opioid. Oxycodone increased as first prescribed opioid (from 44% to 85%) whereas tramadol decreased (64-11%), but their dosage remained stable (stronger opioids were preferred by prescribers). An increase in the first prescription of 1% MME resulted in a 0.43%/0.37% increase in total MME (KA/HA, respectively). A 100 MME increase in dose of the first dispensed opioid had a small effect on long-term use (prevalence: 25% KA, 20% HA) (odds ratio=1.02/1.01 for KA/HA, respectively). Orthopaedic surgeons increasingly prescribed the first prescription between 2013 and 2018 (44-69%). General practitioners mostly prescribed consecutive prescriptions (>50%). CONCLUSION Oxycodone increased as first out-of-hospital prescription between 2013 and 2018. The dose of the first prescribed opioid was associated with the total dose and a small increased risk of prolonged use. First prescriptions were mostly written by orthopaedic surgeons and consecutive prescriptions by general practitioners.
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Affiliation(s)
- Heather E van Brug
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Rob G H H Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands; Dutch Arthroplasty Register (LROI), s-Hertogenbosch, the Netherlands
| | - Frits R Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Eveline L A van Dorp
- Department of Anesthesiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Marcel L Bouvy
- Utrecht Institute for Pharmaceutical Sciences (UIPS), Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, the Netherlands
| | - Albert Dahan
- Department of Anesthesiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Maaike G J Gademan
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
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Klenø AN, Sørensen HT, Pedersen AB. Time trends in use of non-steroidal anti-inflammatory drugs and opioids one year after total hip arthroplasty due to osteoarthritis during 1996-2018: a population-based cohort study of 103,209 patients. Osteoarthritis Cartilage 2022; 30:1376-1384. [PMID: 35918050 DOI: 10.1016/j.joca.2022.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 06/10/2022] [Accepted: 07/14/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine time trends in the use of NSAIDs and opioids for patients with osteoarthritis undergoing total hip arthroplasty (THA) during 1996-2018. METHOD Using Danish population-based medical databases, we identified 103,209 THA patients. Prevalence rates of NSAID and opioid use among preoperative users and non-users were calculated in four quarters (Q1-Q4) after THA by calendar periods (1996-2000, 2001-2006, 2007-2012 and 2013-2018). Prevalence rate ratios (PRR) were adjusted for age and gender. RESULTS Among preoperative NSAID users and non-users, NSAID use in Q1 increased from 32.6% in 1996-2000 to 48.0% in 2013-2018 (PRR = 1.49, 95% CI: 1.42-1.55) and from 12.9% to 32.0% (PRR = 2.49 (2.32-2.67)), respectively. Among preoperative opioid users and non-users, opioid use in Q1 increased from 42.7% in 1996-2000 to 76.9% in 2013-2018 (PRR = 1.81 (1.73-1.89)) and from 15.2% to 58.2% (PRR = 3.85 (3.65-4.05)), respectively. NSAID use in Q4 decreased from 24.5% in 1996-2000 to 21.4% in 2013-2018 (PRR = 0.88 (0.83-0.93)) and from 6.9% to 5.6% (PRR = 0.81 (0.73-0.91)) in preoperative NSAIDs users and non-users, respectively. Opioid use in Q4 increased from 26.6% in 1996-2000 to 28.6% (PRR = 1.08 (1.02-1.15)) in 2013-2018 and from 4.1% to 5.0% (PRR = 1.25 (1.11-1.40)) in preoperative opioid users and non-users, respectively. CONCLUSION We observed up to a 4-fold increase in NSAID and opioid use in Q1 during 1996-2018, while usage in Q4 did not change substantially. However, 5-6% of the preoperative non-users of NSAIDs and opioids were users in Q4, which might relate to inaccurate indication for or timing of THA and the post-surgical phasing out of analgesics use.
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Affiliation(s)
- A N Klenø
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Århus N, Denmark.
| | - H T Sørensen
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Århus N, Denmark.
| | - A B Pedersen
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Århus N, Denmark.
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