Association of reported NSAID adverse drug reactions with opioid prescribing following total joint arthroplasty

by Selleckchem | Apr 14 2023

Background: Nonsteroidal anti-inflammatory drugs (NSAIDs) are indicated for post-operative pain management, but use may be precluded by report of adverse drug reactions (ADRs). The effect of NSAID ADR labeling on opioid prescribing following total joint arthroplasty (TJA) is unknown.

Objective: To assess the association between NSAID ADRs and post-operative opioid prescribing following TJA, a common surgical procedure.

Methods: We performed a retrospective cohort study of adults undergoing total joint (knee or hip) replacement in a single hospital network between 4/1/2016-12/31/2019. Demographic information, clinical and surgical characteristics, and prescription data were obtained from the electronic health record. We studied the association between reported NSAID ADRs and post-operative opioid prescribing in a propensity score-matched sample over one year of follow-up.

Results: NSAID ADRs were reported by 9.6% of the entire cohort (n=584/6,091). NSAID ADR was associated with 41% higher odds of receipt of opioid prescriptions at 181-365 days following hospital discharge (95% confidence interval 13%-75%) in a propensity score-matched sample. Over 98% of individuals received an opioid prescription at time of hospital discharge, with no difference in overall median opioid dose prescribed by NSAID ADR status. However, more patients with NSAID ADRs (7.6% vs 4.7%) received cumulative opioid doses ≥750 morphine milligram equivalents (MME) at discharge (p=0.004).

Conclusion: Reported NSAID ADR was associated with increased risk for prolonged receipt of opioids at 181-365 days post-operatively. Patients with NSAID ADRs more frequently received cumulative opioid doses ≥750 MME at discharge following TJA. Clarification and evaluation of reported NSAID ADRs may be particularly beneficial for surgical patients at high risk for prolonged receipt of opioids.

Comments：

In this retrospective cohort study, the authors investigated the association between reported adverse drug reactions (ADRs) to nonsteroidal anti-inflammatory drugs (NSAIDs) and post-operative opioid prescribing in patients who underwent total joint (knee or hip) replacement surgery. The study was conducted in a single hospital network between April 1, 2016, and December 31, 2019.

The authors collected demographic, clinical, and surgical data, as well as prescription information, from the electronic health records of 6,091 patients who underwent total joint replacement. They found that 584 (9.6%) of the patients reported NSAID ADRs. The study showed that patients with reported NSAID ADRs had a 41% higher odds ratio of receiving opioid prescriptions at 181-365 days following hospital discharge, compared to patients without reported NSAID ADRs.

The study also found that over 98% of all patients received an opioid prescription at the time of hospital discharge, with no difference in the overall median opioid dose prescribed by NSAID ADR status. However, patients with reported NSAID ADRs were more likely to receive cumulative opioid doses ≥750 morphine milligram equivalents (MME) at discharge (7.6% vs. 4.7%).

The authors suggest that clarification and evaluation of reported NSAID ADRs may be particularly beneficial for surgical patients at high risk for prolonged receipt of opioids. Overall, the study highlights the need for clinicians to consider the potential impact of reported ADRs to NSAIDs on post-operative pain management and opioid prescribing.