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Liu S, Patanwala AE, Naylor JM, Levy N, Knaggs R, Stevens JA, Bugeja B, Begley D, Khor KE, Lau E, Allen R, Adie S, Penm J. Impact of modified-release opioid use on clinical outcomes following total hip and knee arthroplasty: a propensity score-matched cohort study. Anaesthesia 2023; 78:1237-1248. [PMID: 37365700 PMCID: PMC10952779 DOI: 10.1111/anae.16070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2023] [Indexed: 06/28/2023]
Abstract
Modified-release opioids are often prescribed for the management of moderate to severe acute pain following total hip and knee arthroplasty, despite recommendations against their use due to increasing concerns regarding harm. The primary objective of this multicentre study was to examine the impact of modified-release opioid use on the incidence of opioid-related adverse events compared with immediate-release opioid use, among adult inpatients following total hip or knee arthroplasty. Data for total hip and knee arthroplasty inpatients receiving an opioid analgesic for postoperative analgesia during hospitalisation were collected from electronic medical records of three tertiary metropolitan hospitals in Australia. The primary outcome was the incidence of opioid-related adverse events during hospital admission. Patients who received modified with or without immediate-release opioids were matched to those receiving immediate-release opioids only (1:1) using nearest neighbour propensity score matching with patient and clinical characteristics as covariates. This included total opioid dose received. In the matched cohorts, patients given modified-release opioids (n = 347) experienced a higher incidence of opioid-related adverse events overall, compared with those given immediate-release opioids only (20.5%, 71/347 vs. 12.7%, 44/347; difference in proportions 7.8% [95%CI 2.3-13.3%]). Modified-release opioid use was associated with an increased risk of harm when used for acute pain during hospitalisation after total hip or knee arthroplasty.
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Affiliation(s)
- S. Liu
- Faculty of Medicine and Health, School of PharmacyThe University of SydneySydneyNSWAustralia
- Department of PharmacyPrince of Wales HospitalRandwickNWSAustralia
| | - A. E. Patanwala
- Faculty of Medicine and Health, School of PharmacyThe University of SydneySydneyNSWAustralia
- Pharmacy DepartmentRoyal Prince Alfred HospitalCamperdownNSWAustralia
| | - J. M. Naylor
- Orthopaedic Department, Whitlam Orthopaedic Research CentreLiverpool HospitalLiverpoolNSWAustralia
- South Western Sydney Clinical SchoolUniversity of New South WalesSydneyNSWAustralia
| | - N. Levy
- Department of Anaesthesia and Peri‐operative MedicineWest Suffolk HospitalBury St. EdmundsUK
| | - R. Knaggs
- School of PharmacyUniversity of Nottingham and Primary Integrated Community ServicesNottinghamUK
| | - J. A. Stevens
- School of Clinical Medicine, St Vincent's Clinical CampusUniversity of New South WalesSydneyNSWAustralia
- School of MedicineUniversity of Notre DameSydneyNSWAustralia
| | - B. Bugeja
- Department of Pain ManagementPrince of Wales HospitalSydneyNSWAustralia
| | - D. Begley
- Department of Pain ManagementPrince of Wales HospitalSydneyNSWAustralia
| | - K. E. Khor
- Department of Pain ManagementPrince of Wales HospitalSydneyNSWAustralia
- Prince of Wales Clinical SchoolUniversity of New South Wales Medicine and HealthSydneyNSWAustralia
| | - E. Lau
- Department of PharmacySt George HospitalKogarahNSWAustralia
| | - R. Allen
- Pain Management UnitSt George HospitalKogarahNSWAustralia
| | - S. Adie
- St George and Sutherland Clinical SchoolUniversity of New South WalesSydneyNSWAustralia
| | - J. Penm
- Department of PharmacyPrince of Wales HospitalRandwickNWSAustralia
- Faculty of Medicine and Health, School of PharmacyThe University of SydneySydneyNSWAustralia
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Awadalla R, Liu S, Kemp-Casey A, Gnjidic D, Patanwala A, Stevens J, Begley D, Bugeja B, Penm J. Impact of an Australian/New Zealand organisational position statement on extended-release opioid prescribing among surgical inpatients: a dual centre before-and-after study. Anaesthesia 2021; 76:1607-1615. [PMID: 33954980 DOI: 10.1111/anae.15500] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2021] [Indexed: 12/23/2022]
Abstract
Extended-release opioids are often prescribed to manage postoperative pain despite being difficult to titrate to analgesic requirements and their association with long-term opioid use. An Australian/New Zealand organisational position statement released in March 2018 recommended avoiding extended-release opioid prescribing for acute pain. This study aimed to evaluate the impact of this organisational position statement on extended-release opioid prescribing among surgical inpatients. Secondary objectives included predictors and clinical outcomes of prescribing extended-release opioids among surgical inpatients. We conducted a retrospective, dual centre, 11-month before-and-after study and time-series analysis by utilising electronic medical records from two teaching hospitals in Sydney, Australia. The primary outcome was the proportion of patients prescribed an extended-release opioid. For surgical patients prescribed any opioid (n = 16,284), extended-release opioid prescribing decreased after the release of the position statement (38.4% before vs. 26.6% after, p < 0.001), primarily driven by a reduction in extended-release oxycodone (31.1% before vs. 14.1% after, p < 0.001). There was a 23% immediate decline in extended-release opioid prescribing after the position statement release (p < 0.001), followed by an additional 0.2% decline per month in the following months. Multivariable regression showed that the release of the position statement was associated with a decrease in extended-release opioid prescribing (OR 0.54, 95%CI 0.50-0.58). Extended-release opioid prescribing was also associated with increased incidence of opioid-related adverse events (OR 1.52, 95%CI 1.35-1.71); length of stay (RR 1.44, 95%CI 1.39-1.51); and 28-day re-admission (OR 1.26, 95%CI 1.12-1.41). Overall, a reduction in extended-release opioid prescribing was observed in surgical inpatients following position statement release.
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Affiliation(s)
- R Awadalla
- Faculty of Medicine and Health, School of Pharmacy, University of Sydney, Sydney, NSW, Australia
| | - S Liu
- Department of Pharmacy, Prince of Wales Hospital, Randwick, NSW, Australia
| | - A Kemp-Casey
- Quality Use of Medicines and Pharmacy Research Centre, Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia
| | - D Gnjidic
- Faculty of Medicine and Health, School of Pharmacy, University of Sydney, Sydney, NSW, Australia
| | - A Patanwala
- Faculty of Medicine and Health, School of Pharmacy, University of Sydney, Sydney, NSW, Australia
| | - J Stevens
- University of New South Wales, Sydney, NSW, Australia.,University of Notre Dame, Sydney, NSW, Australia
| | - D Begley
- Department of Pain Management, Prince of Wales Hospital, Randwick, NSW, Australia
| | - B Bugeja
- Department of Pain Management, Prince of Wales Hospital, Randwick, NSW, Australia
| | - J Penm
- Department of Pharmacy, Prince of Wales Hospital, Randwick, NSW, Australia.,Faculty of Medicine and Health, School of Pharmacy, University of Sydney, Sydney, NSW, Australia
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