Background: Prescription opioids are often used before and after orthopaedic surgery. Preoperative opioid use has been linked with worse pain after surgery, surgical outcomes, and increased healthcare expenditure. Long-term postoperative opioid use is also associated with harms such as opioid tolerance and dependence.
Objectives: The objective of this study was to examine the predictors of opioid use before and after orthopaedic surgery across metropolitan, regional and rural hospitals in Australia.
Methods: We conducted a prospective cross-sectional study of patients awaiting elective orthopaedic surgery between April 2017 and November 2019. Five hospitals across a range of metropolitan to rural, and public and private settings were included. Data on baseline demographics, pain intensity and analgesic use were collected two to six weeks preoperatively and 90 days postoperatively.
Results: There were 430 patients included, of whom 53% were female and the mean age was 68 years (standard deviation 10 years). The inner regional hospital setting was a significant predictor of opioid use before (adjusted odds ratio [aOR], 2.6; 95% confidence interval [CI], 1.0 – 6.7) and after orthopaedic surgery (aOR, 12.26; 95% CI, 2.2 – 68.2) after adjusting for covariates. In addition, the outer regional location was a significant predictor for long-term postoperative opioid use (aOR, 5.46; 95% CI, 1.1 – 27.5).
Conclusions: The regional hospital setting was a significant predictor of opioid use before and after orthopaedic surgery. Understanding the local context when addressing preoperative and postoperative opioid use may facilitate improved pain management among patients undergoing orthopaedic surgery.
