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


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.



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

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