When more drugs or more potent ones is harmful also on the long term!

Long-term Analgesic Use After Low-Risk Surgery

A Retrospective Cohort Study

Asim Alam, MD; Tara Gomes, MHSc; Hong Zheng, MSc; Muhammad M. Mamdani, PharmD, MA, MPH; David N. Juurlink, MD, PhD; Chaim M. Bell, MD, PhD 

Arch Intern Med. 2012;172(5):425-430. doi:10.1001/archinternmed.2011.1827

Background  This study evaluated the risk of long-term analgesic use after low-risk surgery in older adults not previously prescribed analgesics.

Methods  We conducted a retrospective cohort study using linked, population-based administrative data in Ontario, Canada, from April 1, 1997, through December 31, 2008. We identified Ontario residents 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, 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, we examined the risk of long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs). We used multivariate logistic regression to examine the association between postsurgical use of analgesics and long-term use.

Results  Among 391 139 opioid-naive patients undergoing short-stay surgery, opioids were newly prescribed to 27 636 patients (7.1%) within 7 days of being discharged from the hospital, and opioids were prescribed to 30 145 patients (7.7%) at 1 year from surgery. An increase in the use of oxycodone was found during this time (from 5.4% within 7 days to 15.9% at 1 year). In our primary analysis, patients receiving an opioid prescription within 7 days of surgery were 44% more likely to become long-term opioid users within 1 year compared with those who received no such prescription (adjusted odds ratio, 1.44; 95% CI, 1.39-1.50). In a secondary analysis, among 383 780 NSAID-naive patients undergoing short-stay surgery, NSAIDs were prescribed to 1169 patients (0.3%) within 7 days of discharge and to 30 080 patients (7.8%) at 1 year from surgery. Patients who began taking NSAIDs within 7 days of surgery were almost 4 times more likely to become long-term NSAID users compared with patients with no such prescription (adjusted odds ratio, 3.74; 95% CI, 3.27-4.28).

Conclusion  Prescription of analgesics immediately after ambulatory surgery occurs frequently in older adults and is associated with long-term use.