title: Long-term analgesic use after low-risk surgery: a retrospective cohort study.
abstract: BACKGROUND
  This study evaluated the risk of long-term analgesic use after low-risk surgery in older adults not previously prescribed analgesics.
  
  
  METHODS
  We conducted a retrospective cohort study using linked, population-based administrative data in Ontario, Canada, from April 1, 1997, through December 31, 2008. We identified Ontario residents 66 years and older who were dispensed an opioid within 7 days of a short-stay surgery (cataract surgery, laparoscopic cholecystectomy, transurethral resection of the prostate, or varicose vein stripping) and assessed the risk of long-term opioid use, defined as a prescription for an opioid within 60 days of the 1-year anniversary of the surgery. In a secondary analysis, we examined the risk of long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs). We used multivariate logistic regression to examine the association between postsurgical use of analgesics and long-term use.
  
  
  RESULTS
  Among 391,139 opioid-naive patients undergoing short-stay surgery, opioids were newly prescribed to 27,636 patients (7.1%) within 7 days of being discharged from the hospital, and opioids were prescribed to 30,145 patients (7.7%) at 1 year from surgery. An increase in the use of oxycodone was found during this time (from 5.4% within 7 days to 15.9% at 1 year). In our primary analysis, patients receiving an opioid prescription within 7 days of surgery were 44% more likely to become long-term opioid users within 1 year compared with those who received no such prescription (adjusted odds ratio, 1.44; 95% CI, 1.39-1.50). In a secondary analysis, among 383,780 NSAID-naive patients undergoing short-stay surgery, NSAIDs were prescribed to 1169 patients (0.3%) within 7 days of discharge and to 30,080 patients (7.8%) at 1 year from surgery. Patients who began taking NSAIDs within 7 days of surgery were almost 4 times more likely to become long-term NSAID users compared with patients with no such prescription (adjusted odds ratio, 3.74; 95% CI, 3.27-4.28).
  
  
  CONCLUSIONS
  Prescription of analgesics immediately after ambulatory surgery occurs frequently in older adults and is associated with long-term use.
authors.affiliation: Department of Anesthesiology, University of Toronto, Ontario, Canada.
authors.forename: Asim
authors.initials: A
authors.lastname: Alam
authors.forename: Tara
authors.initials: T
authors.lastname: Gomes
authors.forename: Hong
authors.initials: H
authors.lastname: Zheng
authors.forename: Muhammad M
authors.initials: MM
authors.lastname: Mamdani
authors.forename: David N
authors.initials: DN
authors.lastname: Juurlink
authors.forename: Chaim M
authors.initials: CM
authors.lastname: Bell
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D016022:Case-Control Studies; D016001:Confidence Intervals; D004334:Drug Administration Schedule; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008134:Long-Term Care; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D016017:Odds Ratio; D009864:Ontario; D010149:Postoperative Pain / Q000175:diagnosis / Q000188:drug therapy*; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000009:adverse effects / Q000379:methods; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid