Opioid Use and Pain Control in the Elderly After Elective or Urgent Orthopaedic Surgery: A Retrospective Cohort Study.

Abstract

As an increasing number of elderly are undergoing orthopaedic procedures, it is important to understand and evaluate postoperative pain management in this population, especially in regard to opioid use. Data in the literature pertaining to the very elderly remains scarce. This study was conducted to evaluate whether older patients require lower opioid doses than their younger counterparts after undergoing an elective or urgent orthopaedic procedure, and to assess the cumulative incidence of adverse events and length of stay for each age group. A retrospective cohort study was performed to compare the mean opioid use and pain control between two groups of elderly patients (65-79years and ≥ 80years of age). The study included 250 patients who underwent either an elective arthroplasty or urgent orthopaedic surgery following a fracture. Data were collected during the 7days following surgery. No significant difference was found in mean and maximal pain scores between the two groups. Opioid use (expressed in intravenous morphine equivalents) was higher in the younger group. The difference reached statistical significance on the first postoperative day (subjects 65-79 years of age taking 21.3mg, vs. 10.9mg for the group over 80years of age; mean difference 10.3 mg, 95% confidence interval 1.3-19.4). This was also observed in patients undergoing elective surgery on postoperative days 1, 5, 6 and 7. No difference in opioid use was observed between age groups in patients undergoing urgent surgery. Acute cognitive status deterioration, delirium, oxygen desaturation and constipation were observed more frequently in the older group, while mean length of stay was higher in the older group undergoing urgent surgery (8 vs. 17 days, p<0.001). Our findings further support age-related differences in opioid requirements during the postoperative context after elective orthopaedic surgery, while no difference was found between age groups after urgent surgery.