Post-operative opioid pain management patterns for patients who receive hip surgery

Abstract

BackgroundIdentifying optimal, post-operative opioid management strategies is a priority of health providers and government agencies. At present, there are no studies we are aware of that have formally investigated opioid prescribing patterns for post-operative non-arthroplasty orthopedic conditions such as femoroacetabular impingement, nor has any study investigated the influence of opioid prescription patterns on health care costs and utilization. We aimed to investigate a subgrouping scheme associated with post-operative opioid prescription strategies and measure the subgroups’ direct and indirect health care utilization and costs in individuals undergoing non-arthroplasty orthopedic hip surgery.MethodsThe study was an observational cohort of routine military clinical practices. We used cluster analysis to characterize pre-operative (12 months) and post-operative (24 months) opioid prescription patterns. Linear mixed effects modeling (with statistical controls for baseline status) identified opioid prescription pattern subgroups and identified subgroup differences in health care utilization and costs.ResultsTwo distinct clusters were identified representing 1) short-duration, high total days’ supply (SD-HD), and 2) long-duration, lesser total days’ supply (LD-LD) post-operative prescription patterns. Significantly higher costs and health care utilization for both hip-related and non-hip-related variables were consistently identified in the SD-HD group.ConclusionsLong-term opioid prescription use has been identified as a concern, but our findings demonstrate that LD-LD post-operative opioid management for hip surgery recipients was associated with lower costs and utilization. Whether these management patterns were a reflection of pre-operative health status, impacted pain-related outcomes, or can be replicated in other orthopedic procedures remains a consideration for future studies.Trial registrationNA.

Predictors of chronic prescription opioid use after orthopedic surgery: derivation of a clinical prediction rule.

“…Orthopedic surgeons are the third highest prescribers of opioid pain medication (Morris and Mir 2015 ), as they must help their patients adequately manage acute pain during the postoperative period. Dosage patterns of opioid prescriptions have been shown to influence chronic opioid use after orthopedic surgery (Cook et al 2017 ; Kim et al 2017 ), but there may be other influential variables that help predict chronic use.…”

Manejo da dor pós-operatória

“…Os opióides têm indicação precisa para uso no pós-operatório imediato, porém, seu uso a médio e longo prazo para a dor pós-operatória carece de evidências (Cook, et al, 2017). Pacientes que usam opioides também no pré-operatório têm chance maior de desenvolver tolerância e dependência e a monitorização próxima dos seus efeitos adversos é recomendada (Lespacio, et al, 2019).…”

Preoperative and Postoperative Opioid Prescription Rates in the Total Hip Replacement Surgical Patient

“…Currently, there are no federal prescription or dispensing limits to the quantities of Schedule II opioid drugs. The most common opioids prescribed for pain management after THR are hydrocodone, oxycodone, and tramadol (C. E. Cook et al, 2017; D. J. Cook et al, 2019; Jin et al, 2019; Tan et al, 2018).…”