Opioid Use and Pain Control in the Elderly After Elective or Urgent Orthopaedic Surgery: A Retrospective Cohort Study
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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.
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.
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.
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).
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.
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.
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.
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.
Institutional Ethics Board approval was obtained for this study.
For this type of study, formal consent is not required, as deemed by our Institutional Ethics Board.
- 3.World Health Organization. World report on ageing and health 2015. https://www.who.int/ageing/publications/world-report-2015/en/. Accessed 9 Dec 2018.
- 4.United Nations, Department of Economic and Social Affairs, Population Division. World Population Ageing 2017. http://www.un.org/en/development/desa/population/publications/pdf/ageing/WPA2017_Highlights.pdf. Accessed 9 Dec 2018.
- 7.National Opioid Use Guideline Group. Cluster 4: Treating Specific Populations with LTOT—Elderly patients. Canadian Guideline for safe and effective use of opioids for Chronic Non-Cancer Pain—Part B (recommendations for practice) 2010; 51:1-9.Google Scholar
- 8.American Society of Anesthesiologists Task Force on Acute Pain Management. Practice guidelines for acute pain management in the perioperative setting an updated report by the American Society of Anesthesiologists Task Force on Acute Pain Management. Anesthesiology. 2012;116:248–73.CrossRefGoogle Scholar
- 24.Bozzer C, Popovec B, Béique M, et al. MUHC opioid therapy guidelines: safe and effective prescribing of opioids for acute pain in adults. Montreal: McGill University Health Center; 2008. p. 1–8.Google Scholar