Impact of modified-release opioid use on clinical outcomes following total hip and knee arthroplasty: a propensity score-matched cohort study

• Published in: Anaesthesia Vol. 78; no. 10; pp. 1237 - 1248
• Main Authors: Liu, S, Patanwala, A E, Naylor, J M, Levy, N, Knaggs, R, Stevens, J A, Bugeja, B, Begley, D, Khor, K E, Lau, E, Allen, R, Adie, S, Penm, J
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01.10.2023; John Wiley and Sons Inc
• Subjects: Acute Pain - drug therapy; Adult; Adverse events; Analgesia; Analgesics; Analgesics, Opioid - therapeutic use; Arthroplasty (hip); Arthroplasty (knee); Arthroplasty, Replacement, Hip - adverse effects; Arthroplasty, Replacement, Knee - adverse effects; Biomedical materials; Cohort analysis; Cohort Studies; Electronic health records; Electronic medical records; Hip; Hospitals; Humans; Joint replacement surgery; Knee; Narcotics; Opioid-Related Disorders - etiology; Opioids; Original; Pain; Pain perception; Pain, Postoperative - drug therapy; Patients; Propensity Score; Retrospective Studies; total hip arthroplasty; total knee arthroplasty; adverse events; modified-release; opioids
• ISSN: 0003-2409; 1365-2044
• DOI: 10.1111/anae.16070

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.