Persistence of opioid use following surgical admission
Investigators: Dr Tina Lam (MARC), Dr Ting Xia (MARC), Nicholas Biggs (NostraData), John Evans (Slade Pharmacy), Mike da Gama (NostraData), Prof Dan Lubman (Turning Point & MARC).
The type of opioid prescribed to patients following surgery can impact long-term use, a new study has found.
The study, the first of its kind in Australia, compared the opioid-types tapentadol and oxycodone on the outcome of longer-term use, and found lower rates of longer-term use for patients prescribed tapentadol in particular surgical sub groups.
Clinical guidelines suggest that the administering of pain medication should usually cease within one week post surgery. The study looked at patients who were continuing to use opioids three months post surgery, a period when most people are expected to no longer be taking pain relieving medication.
The study analysed the records of 120,000 hospital patients who were discharged from surgery across three Australian states. The study examined various subgroups of these patients, including by the type of surgery they had, whether they were prescribed immediate release or slower-release opioid formulations, and whether they had a history of using opioids prior to surgery. Most patients are not using opioids prior to surgery (are “opioid naive”), and the clinical guidelines recommend immediate release formulations for post-surgical analgesia. So, the main group of interest for this study were opioid naive patients who were prescribed immediate release formulations at discharge.
Opioid naive patients on immediate release opioids were analysed twice – firstly as one large group of patients who were discharged from different types of surgeries, and secondly by examining only the patients who had orthopaedic surgery. The first analysis which combined the 66,000 patients with different types of surgeries did not find any significant effect of discharge opioid type on opioid use at 3 months after surgery. In contrast, the sub-analysis with 20,000 orthopaedic patients found tapentadol was associated with lower odds of longer-term use.
Historically, oxycodone has been routinely prescribed as the main analgesic for post-surgical pain relief. While tapentadol has been on the market for the best part of 10 years, it has only been in the last five years that it has been more widely used.
Around 70 percent of patients are prescribed postoperative opioids, and patients who are commenced on opioids in hospital are at risk of developing long-term opioid use. Given this is one of the first studies specifically looking at tapentadol as a discharge opioid on longer-term outcomes, the clinical outcomes may see clinicians take into consideration the longer-term side effects of these opioids when prescribing post operative pain relief to patients.
The study has been published in Anaesthesia, the official journal of the Association of Anaesthetists. To read the full open-access paper, visit:
https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/anae.15933
Publications
Protocol of study
Lam, T., Biggs, N., Xia, T., Evans, J., Stevens, J., da Gama, M., Lubman, D. I., & Nielsen, S. (2022). Comparing opioid types in the persistence of opioid use following surgical admission: a study protocol for a retrospective observational linkage study comparing tapentadol and oxycodone in Australia. BMJ open, 12(4), e060151. https://doi.org/10.1136/bmjopen-2021-060151.
Study main findings
Lam T, Xia T, Biggs N, Treloar M, Cheng O, Kabu K, Stevens J, Evans J, da Gama M, Lubman D, Nielsen S. (2022). The effect of discharge opioid on persistent postoperative opioid use: a retrospective cohort study comparing tapentadol and oxycodone. Anaesthesia, 78:420-431. DOI: 10.1111/anae.15933
Contact
For further information please contact Dr Tina Lam (MARC).
Project Funder
The study was funded by an untied educational grant from CSL Seqirus.
Project Partners
A collaboration between MARC, NostraData, Slade Pharmacy, IQVIA, St Vincent's Clinical School UNSW and Turning Point.