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Long-term analgesic use after low-risk surgery: a retrospective cohort study

Alam A, Gomes T, Zheng H, Mamdani MM, Juurlink DN, Bell CM. Arch Intern Med. 2012; 172(5):425-30.

Objective — To evaluate the risk of long-term analgesic use after low-risk surgery in older adults not previously prescribed analgesics.

Methods — The researchers conducted a retrospective cohort study using linked, population-based administrative data in Ontario, Canada between April 1, 1997 and December 31, 2008. The researchers identified Ontario residents aged 66 years and older who were dispensed an opioid within 7 days of a short stay surgery (cataract surgery, laparoscopic cholecystectomy, transurethral resection of the prostate (TURP) or varicose vein stripping) and assessed the risk of long-term opioid use, defined as a prescription for an opioid within 60 days of the 1-year anniversary of the surgery. In a secondary analysis, the researchers examined the risk of long-term use of non-steroidal anti-inflammatory drugs (NSAIDs). The researchers used multivariate logistic regression to examine the association between post-surgical initiation of analgesics and long-term use.

Results — Among 391,139 opioid-naïve patients undergoing short-stay surgery, opioids were newly prescribed to 27,636 (7.1%) patients within 7 days of being discharged from hospital and 30,145 (7.7%) patients were prescribed opioids at one year from surgery. There was an increase in the use of oxycodone over this time (from 5.4% within 7 days to 15.9% at one year). In the primary analysis, patients receiving an opioid prescription within 7 days of surgery were 44% more likely to become chronic opioid users within one year, as compared with those who received no such prescription (adjusted odds ratio (aOR) 1.44, 95% confidence interval (CI) 1.39 to 1.50). In a secondary analysis, among 383,780 NSAID–naïve patients undergoing short-stay surgery, NSAIDS were prescribed to 1,169 (0.3%) patients within 7 days of discharge and to 30,080 (7.8%) patients at one-year from surgery. Patients who initiated NSAIDs within 7 days of surgery were almost four times more likely to become chronic NSAID users compared with patients with no such prescription (aOR 3.74, 95% CI 3.27 to 4.28).

Conclusions — Initiation of analgesics immediately after ambulatory surgery occurs frequently in older adults and is associated with chronic use.

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Keywords: Drug therapy Drugs (pain) Surgery