Out-of-hospital opioid prescriptions after knee and hip arthroplasty: prescribers and the first prescribed opioid
van Brug, Heather E; Nelissen, Rob G H H; Rosendaal, Frits R; van Steenbergen, Liza N; van Dorp, Eveline L A; Bouvy, Marcel L; Dahan, Albert; Gademan, Maaike G J
(2023) British Journal of Anaesthesia, volume 130, issue 4, pp. 459 - 467
(Article)
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.
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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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Keywords: dosage, hip arthroplasty, knee arthroplasty, opioid prescription, pharmacoepidemiology, prescribers, Anesthesiology and Pain Medicine
ISSN: 0007-0912
Publisher: Oxford University Press
Note: Funding Information: AD declares grants from NWO/NWA TAPTOE, ZonMW, US FDA, Grunenthal GmbH, AMO Pharma, Enalare, MSD, Medtronic for research, educational, speaker, lecture, and consulting fees and study equipment. EvD and MB declare grants from NWO/NWA TAPTOE. All other authors have nothing to declare. Publisher Copyright: © 2023 The Authors
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