A Population-based Cross-sectional Analysis of Extended-release Opioid Dispensing Incidence, Prognostic Factors, and Variation after Total Joint Arthroplasty
Authors' conclusion
One in 10 patients fills an ERO prescription after total hip or knee arthroplasty, a practice with high variation that is predominantly driven by institutional and surgical practice patterns rather than patient factors.
Study context
- Population
- Adults undergoing primary total hip or knee arthroplasty, Ontario, Canada, 2013–2022
- Participants
- 258,642 procedures
- Outcome
- Fulfillment of an extended-release opioid (ERO) prescription
- Follow-up
- Within 7 days of discharge
Methodological detailspopulation-based, linked administrative databases, multilevel logistic regression
- Population-based
- Linked administrative databases
- Multilevel logistic regression
Main finding
As reported in the abstract
Filled a new ERO prescription after discharge
Filled a new ERO prescription after discharge, among 258,642 knee and hip arthroplasty procedures
31,224
12.1%
Observational data: associations, not effects.
Further findings
Predictors of filling a new ERO prescription (multilevel logistic regression)
| OR (95% CI) | ||
|---|---|---|
| Male sexIncreased odds | 1.14 (1.09–1.19) | |
| Opioid Naïve-Exposed-Tolerant score, 2Preoperative opioid exposure; increased odds | 1.21 (1.15–1.27) | |
| Opioid Naïve-Exposed-Tolerant score, 3Preoperative opioid exposure; increased odds | 1.38 (1.20–1.58) | |
| ASA status of IIIIncreased odds | 1.07 (1.01–1.12) | |
| Neuraxial anesthesiaProtective | 0.79 (0.74–0.84) | |
| Peripheral nerve blockProtective | 0.84 (0.79–0.89) | |
| Acute pain service involvementProtective | 0.77 (0.70–0.85) | |
| 0.512Odds ratio (log scale) |
Variation in ERO dispensing (random effects)
- Hospitals: VPC
- 46% (95% CI, 0.4 to 0.54)
- Hospitals: MOR
- 9.3 (95% CI, 6.57 to 15.27)
- Surgeons: VPC
- 26% (95% CI, 0.24 to 0.26)
- Surgeons: MOR
- 5.3 (95% CI, 4.63 to 6.11)
- Anesthetists: VPC
- 1% (95% CI, 0.010 to 0.011)
- Anesthetists: MOR
- 1.4 (95% CI, 1.36 to 1.46)
- Patient-level factors explained a minority of variation
Original publication
A Population-based Cross-sectional Analysis of Extended-release Opioid Dispensing Incidence, Prognostic Factors, and Variation after Total Joint Arthroplasty. Anesthesiology. Published 22 April 2026. doi:10.
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