- Design
- Population-based cohort with propensity overlap weighting, Ontario 2013–2022
- Population
- 258,624 adults after elective total hip or knee arthroplasty
- Primary outcome
- Persistent postoperative opioid use
- Effect
- 6.0% vs 5.2%; aOR 1.08 (1.01–1.15); ED visits aOR 1.16 (1.12–1.21)
This Ontario population study, published in Anesthesiology on 29 September, included 258,624 adults having elective hip or knee replacement between 2013 and 2022. About one in eight (12.1%) filled a new extended-release opioid prescription within a week of discharge.
Persistent postoperative opioid use occurred in 6.0% of those who filled one and 5.2% of those who did not. After weighting, extended-release opioids were associated with slightly higher odds of persistent use (aOR 1.08), 90-day readmission (1.09) and emergency visits (1.16). Unexpectedly, one-year health system costs were lower and days at home very slightly higher.
The differences are small, but guidelines already discourage extended-release opioids for acute pain, and this adds harm signals without clinical benefit. Immediate-release opioids for the shortest time, with regular paracetamol and NSAIDs where suitable, remain the sensible default.
- Avoid starting extended-release opioids for acute pain after arthroplasty.
- Use immediate-release opioids for the shortest period needed.
- Build discharge analgesia on regular paracetamol and NSAIDs where suitable.
- Give patients a clear plan to stop opioids and when to seek review.
Why it matters
A common discharge habit carried small but consistent harms for no clear gain.
Don't overread it
The associations were small and observational; the lower costs are unexplained.
The statistics, in plain English
An adjusted odds ratio of 1.08 means about 8% higher odds of persistent opioid use. In absolute terms that is roughly 6.0% versus 5.2%, under one extra patient per 100.
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