Health Care Costs and Utilization in Patients Receiving Prescriptions for Long-acting Opioids for Acute Postsurgical Pain

Objectives: Severe pain after joint replacement surgeries is common and is usually managed by opioid analgesics. We described joint replacement surgery patients who received prescriptions for long-acting opioids (LAOs) and compared their health care utilization and costs with postsurgical patients who did not receive LAO prescriptions. Materials and Methods: Patients undergoing hip, knee, or shoulder replacement surgery between January 1, 2008 and December 31, 2011 were included in the study and were classified by their exposure to LAOs. We estimated multivariate models to compare the groups' health care utilization and costs in the first 7 days and in the 1, 3, 6, and 12 months after surgery. Results: Of 118,816 patients who met our inclusion criteria, 15,094 (13%) received LAO prescriptions in 30 days following surgery. LAO recipients were slightly younger and more likely than non-recipients to have taken antibiotics, antidepressants, benzodiazepines, antihypertensives, sedatives, muscle relaxants, and short-acting opioids in the 60 days before surgery. LAO recipients were more likely to have had a hospitalization and an emergency department visit in the subsequent 1 week and in the next 1, 3, 6, and 12 months. Patients receiving LAO prescriptions incurred greater costs in the 1 week and in the 1, 3, 6, and 12 months following their surgeries compared with patients who did not receive LAO prescriptions. Discussion: We found associations between patients who received prescriptions for LAOs and increased costs and utilization. Future studies should elucidate causal relationships between LAOs and increased resource use. Providers should consider alternative pain management strategies.