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Opioid Use and Pain Control in the Elderly After Elective or Urgent Orthopaedic Surgery: A Retrospective Cohort Study

  • Vincent Dagenais-BeauléEmail author
  • Jean-François Tourigny
  • Louise Papillon-Ferland
Original Research Article
  • 17 Downloads

Abstract

Background

As an increasing number of elderly are undergoing orthopaedic procedures, it is important to understand and evaluate postoperative pain management in this population, especially in regard to opioid use. Data in the literature pertaining to the very elderly remains scarce.

Objectives

This study was conducted to evaluate whether older patients require lower opioid doses than their younger counterparts after undergoing an elective or urgent orthopaedic procedure, and to assess the cumulative incidence of adverse events and length of stay for each age group.

Methods

A retrospective cohort study was performed to compare the mean opioid use and pain control between two groups of elderly patients (65–79 years and ≥ 80 years of age). The study included 250 patients who underwent either an elective arthroplasty or urgent orthopaedic surgery following a fracture. Data were collected during the 7 days following surgery.

Results

No significant difference was found in mean and maximal pain scores between the two groups. Opioid use (expressed in intravenous morphine equivalents) was higher in the younger group. The difference reached statistical significance on the first postoperative day (subjects 65–79 years of age taking 21.3 mg, vs. 10.9 mg for the group over 80 years of age; mean difference 10.3 mg, 95% confidence interval 1.3–19.4). This was also observed in patients undergoing elective surgery on postoperative days 1, 5, 6 and 7. No difference in opioid use was observed between age groups in patients undergoing urgent surgery. Acute cognitive status deterioration, delirium, oxygen desaturation and constipation were observed more frequently in the older group, while mean length of stay was higher in the older group undergoing urgent surgery (8 vs. 17 days, p < 0.001).

Conclusions

Our findings further support age-related differences in opioid requirements during the postoperative context after elective orthopaedic surgery, while no difference was found between age groups after urgent surgery.

Notes

Acknowledgements

The authors would like thank Van Dong Nguyen for the design, collection and analysis of the data, interpretation of the results and preparation of the manuscript; Louise Mallet, Stephanie Sereda, Ariane Lessard and Krista Brecht for helping with the design of the study; Miguel Chagnon for his assistance in statistical analysis; and Olivier Piché for assistance with the data collection.

Author contributions

VDB and JFT were responsible for the study concept and design, collection and analysis of data, interpretation of results and preparation of the manuscript. LPF assisted with the study concept and design, analysis of data, interpretation of results and editing of the manuscript for important intellectual content.

Compliance with Ethical Standards

Conflicts of interest

Vincent Dagenais-Beaulé, Jean-François Tourigny and Louise Papillon-Ferland have no conflicts of interest directly relevant to the content of this article.

Funding

This work was supported by the Department of Pharmacy, McGill University Health Centre, and the Faculty of Pharmacy, University of Montreal; however, these institutions were not involved in the design, execution, analysis, interpretation of data, or writing of the study.

Ethical approval

Institutional Ethics Board approval was obtained for this study.

Informed consent

For this type of study, formal consent is not required, as deemed by our Institutional Ethics Board.

Supplementary material

40261_2018_744_MOESM1_ESM.pdf (275 kb)
Supplementary material 1 (PDF 276 kb)

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Vincent Dagenais-Beaulé
    • 1
    • 3
    Email author
  • Jean-François Tourigny
    • 2
    • 3
  • Louise Papillon-Ferland
    • 2
  1. 1.Department of Pharmacy Services and Lady Davis InstituteJewish General HospitalMontréalCanada
  2. 2.Department of Pharmacy ServicesMcGill University Health CentreMontréalCanada
  3. 3.Faculty of PharmacyUniversity of MontrealMontréalCanada

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