Nonopioid Analgesic Prescriptions Filled after Surgery among Older Adults in Ontario, Canada: A Population-based Cohort Study

Abstract

Background The objective was to assess changes over time in prescriptions filled for non-opioid analgesics for older post-operative patients in the immediate post-discharge period. We hypothesized that the number of patients who filled a non-opioid analgesic prescription increased over the study period. Methods We performed a population-based cohort study, using linked health administrative data, of 278,366 admissions ≥66 years undergoing surgery between fiscal year 2013 and 2019 in Ontario, Canada. The primary outcome was the percentage of patients with new filled prescriptions for non-opioid analgesics within 7 days of discharge, and a secondary outcome was the analgesic class. We assessed whether patients filled prescriptions for a non-opioid only, an opioid only, both opioid and non-opioid prescriptions, or a combination opioid/non-opioid. Results Overall, 22% (n=60,181) of patients filled no opioid prescription, 2% (n=5,534) filled a non-opioid only, 21% (n=59,608) filled an opioid only, and 55% (n=153,043) filled some combination of opioid and non-opioid. The percentage of patients who filled a non-opioid prescription within 7 days post-operatively increased from 9% (n=2,119) in 2013 to 28% (n=13,090) in 2019, with the greatest increase for acetaminophen: 3% (n=701) to 20% (n=9,559). The percentage of patients who filled a combination analgesic prescription decreased from 53% (n=12,939) in 2013 to 28% (n=13,453) in 2019. However, the percentage who filled both an opioid and nonopioid prescription increased: 4% (n=938) to 21% (n=9,880) so that the overall percentage of patients who received both an opioid and a non-opioid remained constant over time 76% (n= 18,642) in 2013 to 75% (n=35,391) in 2019. Conclusions The proportion of post-operative patients who fill prescriptions for non-opioid analgesics has increased. However, rather than a move to use of non-opioids alone for analgesia, this represents a shift away from combination medications towards separate prescriptions for opioids and non-opioids.

Effect of an intravenous acetaminophen/ibuprofen fixed-dose combination on postoperative opioid consumption and pain after video-assisted thoracic surgery: a double-blind randomized controlled trial

“…A study utilizing large nationwide data in the United States found that the average predicted probability of patients undergoing major surgery being prescribed two or more non-opioid analgesics was 54.2%, with tremendous variation in non-opioid analgesic prescriptions among hospitals [ 21 ]. A recent study in Ontario, Canada, targeting elderly patients aged 66 and over, found that 21% of all patients were prescribed only opioids within one week after surgery [ 22 ]. Although the prescription of non-opioid analgesics showed an increasing trend during the study period, the number of patients receiving a combination of two or more non-opioid analgesics remained low [ 22 ].…”

“…A recent study in Ontario, Canada, targeting elderly patients aged 66 and over, found that 21% of all patients were prescribed only opioids within one week after surgery [ 22 ]. Although the prescription of non-opioid analgesics showed an increasing trend during the study period, the number of patients receiving a combination of two or more non-opioid analgesics remained low [ 22 ]. In addition, according to a survey on perioperative management in thoracic surgery in the UK and Ireland, postoperative use of acetaminophen was reported in 98% of cases, while the use of NSAIDs was only 55% [ 23 ].…”

Scoping review of interventions to de-implement potentially harmful non-steroidal anti-inflammatory drugs (NSAIDs) in healthcare settings

“…3 NSAIDs are available in prescription and over-the-counter (OTC) strengths, a variety of different formulations, and oral (most common), intravenous, injectable and topical forms. The use of NSAIDs has risen globally throughout the last 20 years, [4][5][6][7][8] in part due to increasing rates of chronic and persistent pain and an increasing ageing population.…”

A Scoping Review of Interventions to De-implement Potentially Harmful Nonsteroidal Anti-inflammatory Drugs (NSAIDs) in Healthcare Settings

“…3 NSAIDs are available in prescription and over-the-counter (OTC) strengths, a variety of different formulations, and oral (most common), intravenous, injectable, and topical forms. The use of NSAIDs has risen globally throughout the last twenty years, [4][5][6][7][8] in part due to increasing rates of chronic and persistent pain and an increasing aging population.…”