Opioid Prescribing and Utilization During Acute Inpatient Rehabilitation Admissions

Przybysz, Allison Glinka; Khudeira, Zahra; Khudeira, Sarah; Graham, Joseph; Machino, Kevin; Jacobs, Jackie; Gittler, Michelle S.

doi:10.1093/pm/pnab107

Cited by 4 publications

(3 citation statements)

References 5 publications

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“…This phenomenon has been observed in other rehabilitation populations. 22 One explanation is that while opioid pharmacokinetics are largely similar to younger patients, pharmacodynamic changes have been demonstrated in older patients such that an 80-year-old person needs 50% less opioid than a 40-year-old to achieve the same analgesic effect. 33 Together this would support a downward adjustment of the expected dosing window for older adults undergoing orthopedic rehabilitation.…”

Section: Discussionmentioning

confidence: 99%

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Opioid use in older orthopedic rehabilitation inpatients: a retrospective study

Bilek¹,

Cullen²,

Tan³

et al. 2023

Eur J Phys Rehabil Med

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BACKGROUND While there is much evidence about pain management for orthopedic patients in the immediate perioperative setting, little is known about how opioids are used during inpatient rehabilitation, particularly in older adults. A safe upper limit of 50 mg oral morphine equivalents (OME) is frequently cited in guidelines. AIM The aim of this study was to characterize the dosing of opioids in an older adult population undergoing inpatient orthopedic rehabilitation (IOR). DESIGN Retrospective observational study. SETTING Inpatient units at an academic rehabilitation hospital in Toronto, Canada. POPULATION All adults aged ≥50 years old admitted for orthopedic rehabilitation between November 2019 and June 2021 following acute care admissions for either a surgical or non-surgical orthopedic indication. METHODS Participants were divided into groups of prior opioids users, new opioids users, and opioid non-users during IOR. Demographic, clinical, and medication administration data were collected through the electronic health record and manual chart review. Average daily opioid dose for the first seven days of each stay was characterized using OME. Linear regression was used to assess for variables independently associated with opioid dose. RESULTS A total of 643 patients undergoing orthopedic rehabilitation were included: 125 (19.4%) were prior opioid users, 416 (64.7%) were new opioid users, and 102 (15.9%) were non-users, with median age respectively of 72, 79, and 83. Median daily OME over the first week for prior users was 30.3 and for new users was 6.9. Opioid dose was inversely associated with age and admission for a non-surgical indication; it was positively associated with reported pain (as defined by day 3 pain score) and admission for knee replacement. CONCLUSIONS Opioids are frequently but heterogeneously used in older adults undergoing IOR. Median OME use in this cohort of older adults was substantially lower than the 50 OME threshold suggested in guidelines, particularly for new opioid users. CLINICAL REHABILITATION IMPACT Older adults require much lower opioid doses than younger patients. Pain management in older orthopedic rehabilitation inpatients is distinct from the perioperative setting and deserves tailored guidance, with a focus on using the lowest effective dose.

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Section: Discussionmentioning

confidence: 99%

“… 20 , 21 A recent study examined opioid use during inpatient rehabilitation but focused on a general adult population. 22 However, we were not able to identify any such reports specifically for older IOR patients. We therefore conducted this retrospective study as a preliminary characterization of patients in IOR and their patterns of opioid use.…”

mentioning

confidence: 89%

Opioid use in older orthopedic rehabilitation inpatients: a retrospective study

Bilek¹,

Cullen²,

Tan³

et al. 2023

Eur J Phys Rehabil Med

View full text Add to dashboard Cite

show abstract

“…As many as 87% of patients requiring rehabilitation reported experiencing pain on admission (Cecchi et al, 2018; Morrison et al, 2009) and described worsening pain during physical exercise (Chin et al, 2013; Morrison et al, 2009). Currently, there is little information regarding the use of analgesics for patients in this setting, with only two studies reporting wide ranges of opioid use (16%–63%) among inpatients (Chin et al, 2013; Glinka Przybysz et al, 2021). More research is needed to better clarify patterns of opioid prescriptions during inpatient rehabilitation.…”

mentioning

confidence: 99%