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Prescribing opioids for pain after short-stay surgery appears associated with long-term use

Toronto, March 12, 2012

By Leslie Shepherd

TORONTO, Ont., March 12, 2012--Prescribing opioids for pain to older patients within seven days of short-stay surgery appears to be associated with long-term analgesic use, according to a study published today in the Archives of Internal Medicine.

Patients are frequently prescribed analgesics after ambulatory or short-stay surgery in anticipation of postoperative pain. The most common analgesics prescribed to outpatients are opioids (such as codeine and oxycodone) and nonsteroidal anti-inflammatory drugs (NSAIDS).

While opioids can be beneficial, they are associated with such adverse effects as sedation, constipation and respiratory depression, and their long-term use can lead to physiologic tolerance and addiction.

Dr. Chaim Bell of St. Michael's Hospital and colleagues evaluated whether prescribing analgesics to elderly patients after short-stay surgery was associated with long-term analgesic use. The authors suggest elderly patients are at risk of adverse reactions to pain medicines in this group.

The researchers used population-based administrative data in Ontario from April 1997 through December 2008 to identify patients 66 years and older who were dispensed an opioid within seven days of short-stay surgery for cataracts, laparoscopic gallbladder removal, prostate tissue removal or varicose vein stripping.

During the study period, 391,139 patients met the criteria and 27,636 (7.1 percent) of patients were newly prescribed an opioid within seven days of being discharged from the hospital following short-stay surgery and 30,145 patients (7.7 percent) were prescribed opioids at one year from surgery. A total of 2,857 (10.3 percent) of these patients were identified as long-term opioid users one year after surgery.

"Current opioid use is at epidemic proportions," Dr. Bell said. "Patients are often prescribed opioids after ambulatory and short stay surgeries preemptively in anticipation of post-operative pain. And in many cases, patients are given a standard dose based on the expectation of post-operative pain. However, it is likely that some of these patients did not need the prescription in the first place."

Codeine was the most commonly prescribed opioid for patients who received an early prescription, followed by oxycodone, according to researchers. They noted an increase in oxycodone from 5.4 percent with seven days to 15.9 percent at one year.

A secondary analysis by researchers indicates that patients receiving an early NSAID prescription were 3.7 times more likely to become long-term NSAID users compared with those who did not receive an NSAID prescription within seven days of surgery.

About St. Michael’s Hospital

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in more than 23 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, and care of the homeless are among the Hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Center, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael’s Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.