OPIOID USE PRIOR TO TOTAL KNEE REPLACEMENT: COMPARATIVE ANALYSIS OF TRENDS IN ENGLAND AND SWEDEN

Englund, M; Dell'Isola, A; Thomas, G; Turkiewicz, A; Peat, G; Hellberg, C; Yu, D; Appleyard, T

Abstract

Purpose: Opioids are still frequently used in the pain management of knee osteoarthritis (OA), despite increasing evidence of limited effectiveness, increased morbidity and mortality, as well as risk of addiction. Our aim was to describe and compare trends in the frequency of opioid use in patients with knee OA in England and Sweden in the 10 years prior to total knee replacement (TKR).

Methods: We identified 47,045 patients, aged 45 years and over, from the English national database (Clinical Practice Research Datalink Aurum) and 5,955 patients from the regional Swedish database (Skåne Healthcare register), all undergoing TKR between 2015 and 2019. 1:1 controls, matched on age, sex, and either practice (England) or residential area (Sweden) were randomly selected by risk-set sampling. For each included person, we retrieved information on all prescribed opioids. We estimated the annual prevalence and prevalence rates ratio (PRR) of opioid use in the 10 years prior to TKR (or matched index date for controls) using Poisson regression. In secondary analyses, opioids were stratified by strength (weak/strong), and patterns of use (prevalence and PRR) were explored in the 12-month period (0-3, 4-6, 7-9, and 10-12 months) preceding TKR to investigate the opioid use shortly prior to surgery.

Results: The proportion of patients with OA prescribed any opioid prior to TKR increased towards the date of surgery from 24% to 44% in England, and from 16% to 33% in Sweden, between 10 and 1 years prior to TKR. The prevalence increased gradually from 10 to 3 years, and then sharply rose in the 2 years preceding surgery (Figure 1). Opioid use among controls in both countries was relatively stable, resulting in an increasing PRR, between 1.6 to 2.7 and 1.6 to 2.6, in England and Sweden respectively, 10 to 1 years prior to TKR. Whilst the prevalence of prescribed opioids was higher in England, a majority of cases and controls were using weak opioids (e.g. Codeine and Dihydrocodeine), whereas in Sweden, the proportion using strong opioids (e.g. Tramadol and Morphine) was greater. The PRR of prescribed strong opioids increased from 1.6 to 2.3 in England, and from 1.6 to 2.6 in Sweden, 10 to 1 years preceding TKR. The PRR of prescribed weak opioids increased from 1.6 to 2.7 in England, and from 1.6 to 2.9 in Sweden, 10 to 1 years preceding TKR. No relevant cohort or period effects were observed in either country.

Citation

Englund, M., Dell'Isola, A., Thomas, G., Turkiewicz, A., Peat, G., Hellberg, C., Yu, D., & Appleyard, T. (2022, April). OPIOID USE PRIOR TO TOTAL KNEE REPLACEMENT: COMPARATIVE ANALYSIS OF TRENDS IN ENGLAND AND SWEDEN. Presented at 2022 OARSI World Congress on Osteoarthritis, Berlin, Germany

• Presentation Conference Type: Presentation / Talk
• Conference Name: 2022 OARSI World Congress on Osteoarthritis
• Start Date: Apr 7, 2022
• End Date: Apr 10, 2022
• Publication Date: Mar 28, 2022
• Publicly Available Date: May 30, 2023
• Publisher: Elsevier
• DOI: https://doi.org/10.1016/j.joca.2022.02.081
• Public URL: https://keele-repository.worktribe.com/output/423373
• Publisher URL: https://www.oarsijournal.com/article/S1063-4584(22)00115-7/fulltext