Predictors of the use of analgesic drugs 1 year after joint replacement: a single-center analysis of 13,000 hip and knee replacements

Abstract

Background Pain persists in a moderate number of patients following hip or knee replacement surgery. Persistent pain may subsequently lead to the prolonged consumption of analgesics after surgery and expose patients to the adverse drug events of opioids and NSAIDs, especially in older patients and patients with comorbidities. This study aimed to identify risk factors for the increased use of opioids and other analgesics one year after surgery and focused on comorbidities and surgery-related factors. Methods All patients who underwent a primary hip or knee replacement for osteoarthritis from 2002 to 2013 were identified. Redeemed prescriptions for acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs), and opioids (mild and strong) were collected from a nationwide Drug Prescription Register. The user rates of analgesics and the adjusted risks ratios for analgesic use one year after joint replacement were calculated. Results Of the 6,238 hip replacement and 7,501 knee replacement recipients, 3,591 (26.1%) were still using analgesics one year after surgery. Significant predictors of overall analgesic use (acetaminophen, NSAID, or opioid) were (risk ratio (95% CI)) age 65-74.9 years (reference <65), 1.1 (1.03-1.2), age > 75 years, 1.2 (1.1-1.3), female gender, 1.2 (1.1-1.3), BMI 30-34.9 kg/m2 (reference <25kg/m2), 1.1 (1.04-1.2), BMI >35 kg/m2, 1.4 (1.3-1.6), a higher number of comorbidities (according to modified Charlson Comorbidity Index score), and 1.2 (1.1-1.4). Diabetes and other comorbidities were not significant independent predictors. Of the other clinical factors, the preoperative use of analgesics, 2.6 (2.5-2.8) and knee surgery, 1.2 (1.1-1.3), predicted the use of analgesics, whereas simultaneous bilateral knee replacement (compared to unilateral procedure) was a protective factor, 0.86 (0.77-0.96). Opioid use was associated with obesity, higher CCI score, epilepsy, knee vs hip surgery, unilateral vs bilateral knee operation, total vs unicompartmental knee replacement, and the preoperative use of analgesics/opioids. Conclusions Obesity (especially BMI >35 kg/m2) and the preoperative use of analgesics were the strongest predictors of an increased postoperative use of analgesics. It is remarkable that also older age and higher number of comorbidities predicted analgesic use despite these patients being the most vulnerable to adverse drug events.

Development of Postoperative Pain in Patients with End-Stage Knee Osteoarthritis Is Associated with Upregulation of Genes Related to Extracellular Matrix Degradation, Inflammation, and Apoptosis Measured in the Peripheral Blood before Knee Surgery

“…In addition, the greater incidence of comorbidities, such as arterial hypertension, was associated with a worse outcome of knee surgery in the examined patients with OA, as was also observed before [ 40 ]. Our results are in line with previous studies, which have also shown that obesity was among the strongest predictors of increased postoperative use of analgesics [ 41 ] and can produce negative effects on prosthesis survival [ 15 ].…”

Individualized multidisciplinary analgesia to prevent persistent postsurgical pain

“…In the same population, Rajama ¨ki et al [57] found patients with a history of antidepressant or benzodiazepine use to receive more postoperative prescriptions of analgesics and opioids compared with patients without this history. Preoperative analgesic, benzodiazepine and antidepressant prescriptions, obesity, higher age and the number of comorbidities predicted analgesic prescriptions 1 year after surgery [58]. Register-based studies also have limitations.…”

“…Register-based studies also have limitations. The pharmacological dispensing data do not inform whether the drug was redeemed because of pain in the operated joint or whether the patient has taken the drug or not [58].…”

Knowledge and Reasons for Use of Analgesic Medications among Haramaya University College of Health and Medical Science Students, Harar Town, East Ethiopia

“…Analgesics, NSAIDs and opioids, commonly known as painkillers, are substances which work in various ways to relieve different types of pain experienced in the body. They are also drugs which reduce or relieve the sensation of pain without producing loss of consciousness or parallel depression of other senses [1].…”