Out-of-hospital opioid prescriptions after knee and hip arthroplasty: prescribers and the first prescribed opioid

• Published in: British journal of anaesthesia : BJA Vol. 130; no. 4; pp. 459 - 467
• Main Authors: 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.
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.04.2023
• Subjects: Analgesics, Opioid - therapeutic use; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; dosage; hip arthroplasty; Hospitals; Humans; knee arthroplasty; opioid prescription; Oxycodone; Pain, Postoperative - chemically induced; Pain, Postoperative - drug therapy; pharmacoepidemiology; Practice Patterns, Physicians; prescribers; Prescriptions; Retrospective Studies; opioid prescription; dosage; knee arthroplasty; hip arthroplasty; prescribers; pharmacoepidemiology
• ISSN: 0007-0912; 1471-6771
• DOI: 10.1016/j.bja.2022.12.024

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. 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. 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%). 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.