Abstract
Background:COVID-19 has had a detrimental impact on access to hip and knee arthroplasty surgery. We set outto examine whether this had a subsequent impact on pre-operative opioid prescribing rates forthose awaiting surgery.
Materials and Methods: Data regarding patient demographics and opioid utilisation were collected from the electronichealth records of included patients at a large university teaching hospital. Patients on the outpatientwaiting list for primary hip and knee arthroplasty as of September 2020 (COVID-19 group) werecompared with historical controls (Controls) who had previously undergone surgery. A sample sizecalculation indicated 452 patients were required to detect a 15% difference in opioid prescriptionrates between groups.
Results: A total of 548 patients (58.2% female) were included, 260 in the COVID-19 group, and 288 in theControls. Baseline demographics were similar between the groups. For those with data available,the proportion of patients on any opioid at follow up in COVID-19 group was significantly higher:55.0% (143/260), compared with 41.2% (112/272) in the Controls (p=0.002). This remained significant when adjusted for confounding (age, gender, Scottish Index of Multiple Deprivation, procedure and wait time). The proportion of patients on a strong opioid was similar (4.2% [11/260]versus 4.8% [13/272]) for COVID-19 and Controls respectively. The median waiting time from referral to follow up was significantly longer in the COVID-19 group compared with the Controls (455 days vs367 days; p<0.0001).
Conclusion: The work provides evidence of potential for an emerging opioid problem associated with theinfluence of COVID-19 on elective arthroplasty services. Viable alternatives to opioid analgesia forthose with end-stage arthritis should be explored, and prolonged waiting times for surgery ought tobe avoided in the recovery from COVID-19 to prevent more widespread opioid use.
Materials and Methods: Data regarding patient demographics and opioid utilisation were collected from the electronichealth records of included patients at a large university teaching hospital. Patients on the outpatientwaiting list for primary hip and knee arthroplasty as of September 2020 (COVID-19 group) werecompared with historical controls (Controls) who had previously undergone surgery. A sample sizecalculation indicated 452 patients were required to detect a 15% difference in opioid prescriptionrates between groups.
Results: A total of 548 patients (58.2% female) were included, 260 in the COVID-19 group, and 288 in theControls. Baseline demographics were similar between the groups. For those with data available,the proportion of patients on any opioid at follow up in COVID-19 group was significantly higher:55.0% (143/260), compared with 41.2% (112/272) in the Controls (p=0.002). This remained significant when adjusted for confounding (age, gender, Scottish Index of Multiple Deprivation, procedure and wait time). The proportion of patients on a strong opioid was similar (4.2% [11/260]versus 4.8% [13/272]) for COVID-19 and Controls respectively. The median waiting time from referral to follow up was significantly longer in the COVID-19 group compared with the Controls (455 days vs367 days; p<0.0001).
Conclusion: The work provides evidence of potential for an emerging opioid problem associated with theinfluence of COVID-19 on elective arthroplasty services. Viable alternatives to opioid analgesia forthose with end-stage arthritis should be explored, and prolonged waiting times for surgery ought tobe avoided in the recovery from COVID-19 to prevent more widespread opioid use.
| Original language | English |
|---|---|
| Pages (from-to) | 479-484 |
| Number of pages | 6 |
| Journal | BMJ Quality & Safety |
| Volume | 32 |
| Issue number | 8 |
| Early online date | 14 Sept 2021 |
| DOIs | |
| Publication status | Published - Aug 2023 |
Data Availability Statement
Data are available upon reasonable request.This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.
Additional supplemental material is published online only. To view, please visit the journal online (http://dx.doi.org/10.1136/bmjqs-2021-013450).
Keywords
- Hip
- Knee
- Arthroplasty
- Opioids
- COVID - 19
- Wait