Opioid prescribing patterns after arthroplasty of the knee and hip: a Dutch nationwide cohort study from 2013 to 2018

Heather E van Brug; Rob G H H Nelissen; Willem M Lijfering; Liza N van Steenbergen; Frits R Rosendaal; Eveline L A van Dorp; Marcel L Bouvy; Albert Dahan; Maaike G J Gademan

doi:10.2340/17453674.2022.3993

Authors

Heather E van Brug Department of Orthopaedics, Leiden University Medical Center, Leiden; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden https://orcid.org/0000-0003-4253-9066
Rob G H H Nelissen Department of Orthopaedics, Leiden University Medical Center, Leiden; Dutch Arthroplasty Register (LROI), ‘s-Hertogenbosch https://orcid.org/0000-0003-1228-4162
Willem M Lijfering Department of Clinical Epidemiology, Leiden University Medical Center, Leiden
Liza N van Steenbergen Dutch Arthroplasty Register (LROI), ‘s-Hertogenbosch https://orcid.org/0000-0002-8141-842X
Frits R Rosendaal Department of Clinical Epidemiology, Leiden University Medical Center, Leiden
Eveline L A van Dorp Department of Anaesthesiology, Leiden University Medical Center, Leiden
Marcel L Bouvy Utrecht Institute for Pharmaceutical Sciences (UIPS), Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands
Albert Dahan Department of Anaesthesiology, Leiden University Medical Center, Leiden
Maaike G J Gademan Department of Orthopaedics, Leiden University Medical Center, Leiden; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden https://orcid.org/0000-0002-6106-3385

DOI:

https://doi.org/10.2340/17453674.2022.3993

Keywords:

Arthroplasty, Hip, Knee, Opioids, Osteoarthrosis, Pharmacoepidemiology

Abstract

Background and purpose: Numbers on opioid prescriptions over time in arthroplasty patients are currently lacking. Therefore we determined the annual opioid prescribing rate in patients who received a hip/knee arthroplasty (HA/KA) between 2013 and 2018.
Patients and methods: The Dutch Foundation for Pharmaceutical Statistics, which provides national coverage of medication prescriptions, was linked to the Dutch Arthroplasty Register, which provides arthroplasty procedures. The opioid prescription rates were expressed as the number of defined daily dosages (DDD) and morphine milligram equivalent (MME) per person year (PY) and stratified for primary and revision arthroplasty. Amongst subgroups for age (< 75; ≥ 75 years) and sex for primary osteoarthritis arthroplasties, prescription rates stratified for opioid type (weak/strong) and prevalent preoperative opioid prescriptions (yes/no) were
assessed.
Results: 48,051 primary KAs and 53,964 HAs were included, and 3,540 revision KAs and 4,118 HAs. In 2013, after primary KA 58% were dispensed ≥ 1 opioid within the first year; this increased to 89% in 2018. For primary HA these numbers increased from 38% to 75%. In KAs the prescription rates increased from 13.1 DDD/PY to 14.4 DDD/PY, mainly due to oxycodone prescriptions (2.9 DDD/PY to 7.3 DDD/PY), while tramadol decreased (7.3 DDD/PY to 4.6 DDD/PY). The number of MME/PY also increased (888 MME/PY to 1224 MME/PY). Similar changes were observed for HA and revision arthroplasties. Irrespective of joint, prescription of opioid medication increased over time, with highest levels in groups with preoperative opioid prescriptions while weak opioid prescriptions decreased.
Interpretation: In the Netherlands, between 2013 and 2018 postoperative opioid prescriptions after KA and HA increased, mainly due to increased oxycodone prescriptions with highest levels after surgeries with preoperative prescriptions.