Background: Opioids are commonly used in the postoperative pain management after Total Hip Arthroplasty (THA). The opioid epidemic has raised concerns regarding risks associated with prolonged use and dependence. In this retrospective cohort study, we aimed to establish risk factors for a prolonged opioid use after THA in a Dutch population.

Methods: Retrospective data collection was performed from medical and pharmacy records of 386 patients with a Total Hip Arthroplasty (THA) between 2018 and 2019. Until 6 months postoperative, opioid prescriptions, demographic characteristics, comorbidities, readmissions, complications, ASA classification and polypharmacy (≥5 medications in use) were recorded. A discrete-time survival analysis was performed to investigate risk factors for continuing use of opiate.

Results: Preoperative, 14.2% of the patients used ≥1 opioids at home. Three weeks postoperative 16.6% of the patients had an active prescription for ≥1 opioids, after 6 weeks, 3 months and 6 months this was 7.0%, 2.8% and 2.6 % respectively. Risk factors for postoperative continued used of opiates were pre-operative use of opiates, polypharmacy, a higher ASA score and a longer duration of admission in the rehabilitation center.

Conclusion: Overall, 6 months after THA, the proportion of patients with (an) active opioid prescription(s) was reduced by 82 %. However, risk factors for continued use can be recognized preoperatively. Awareness and intensive monitoring of inappropriate use of opioids in the postoperative phase is recommended.

Elsbeth Wesselink is a hospital pharmacist at the Zaans Medisch Centrum in Zaandam where she is responsible for medication safety in transfer of care and prescription procedures. As a PhD candidate at AmsterdamUMC she has special interest in Perioperative Medication Management. Her recent research activities include two prospective studies with short-acting spinal anesthestics in knee arthroscopy. The abstract of one these studies received a Best of Meeting award at the 44th Annual Regional Anesthesiology and Acute Pain Medicine meeting in Las Vegas, 2019.