Non-opioid analgesic prescriptions filled after surgery among older adults in Ontario, Canada: a population-based cohort study

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.