PERSISTENT POSTOPERATIVE OPIOID USE IN PATIENTS TREATED WITH TOTAL HIP ARTHROPLASTY AND HEMIARTHROPLASTY FOR FEMORAL NECK FRACTURE: A PROPENSITY SCORE-MATCHED ANALYSIS

This study aimed to compare persistent postoperative opioid use across a matched group of patients with femoral neck fracture treated with either total hip arthroplasty (THA) or hemiarthroplasty. Routinely collected health-care databases were linked through ICES to create a population-based cohort of opioid-nai?ve patients ≥66 years old from Ontario, Canada, who underwent THA or hemiarthroplasty for a femoral neck fracture between 2002 and 2016. Propensity-score matching was used to balance potential confounders. Persistent postoperative opioid use was quantified and compared between treatment groups using survival analysis. Over half (55.8%) of patients treated with THA or hemiarthroplasty for femoral neck fracture had not filled an opioid-prescription in the year prior to hip fracture and were considered opioid-nai?ve (n=25,168). Of these patients, 9.2% (n=2,114) were treated with THA, compared to 8.1% of patients who had used opioids in the year prior to hip fracture (relative risk 1.14, 95% CI 1.08–1.21). Approximately 24% opioid-nai?ve patients (n=5,958) filled at least one opioid prescription between 90 days and one year after hip fracture. Use of persistent postoperative opioids was higher in patients All eligible THA patients were adequately matched 1:2 to hemiarthroplasty patients (total matched cohort = 6,492). There was no statistically significant difference in risk of persistent postoperative opioid use between treatment groups (23.2 vs 22.0% for hemiarthroplasty and THA groups, respectively, RR 1.06, 95% CI 0.96–1.17). Results remained similar after accounting for risk of death. Approximately 24% opioid-naive patients fill at least one opioid prescription between three months and one year after undergoing THA or hemiarthroplasty for hip fracture. There was no statistically significant difference in persistent postoperative opioid use between treatment groups. We identified several patient factors associated with increased postoperative opioid use after hip fracture. Targeted preventative intervention strategies and appropriate counselling may be beneficial for this vulnerable population and further exploration of these interventions is required.