Relative risks of adverse events among older adults receiving opioids versus NSAIDs after hospital discharge: A nationwide cohort study

Abstract

Background Although analgesics are initiated on hospital discharge in millions of adults each year, studies quantifying the risks of opioids and nonsteroidal anti-inflammatory drugs (NSAIDs) among older adults during this transition are limited. We sought to determine the incidence and risk of post-discharge adverse events among older adults with an opioid claim in the week after hospital discharge, compared to those with NSAID claims only. Methods and findings We performed a retrospective cohort study using a national sample of Medicare beneficiaries age 65 and older, hospitalized in the United States hospitals in 2016. We excluded beneficiaries admitted from or discharged to a facility. We derived a propensity score that included over 100 factors potentially related to the choice of analgesic, including demographics, diagnoses, surgeries, and medication coadministrations. Using 3:1 propensity matching, beneficiaries with an opioid claim in the week after hospital discharge (with or without NSAID claims) were matched to beneficiaries with an NSAID claim only. Primary outcomes included death, healthcare utilization (emergency department [ED] visits and rehospitalization), and a composite of known adverse effects of opioids or NSAIDs (fall/fracture, delirium, nausea/vomiting, complications of slowed colonic motility, acute renal failure, and gastritis/duodenitis) within 30 days of discharge. After 3:1 propensity matching, there were 13,385 beneficiaries in the opioid cohort and 4,677 in the NSAID cohort (mean age: 74 years, 57% female). Beneficiaries receiving opioids had a higher incidence of death (1.8% versus 1.1%; RR 1.7 [1.3 to 2.3], p < 0.001, number needed to harm [NNH] 125), healthcare utilization (19.0% versus 17.4%; RR 1.1 [1.02 to 1.2], p = 0.02, NNH 59), and any potential adverse effect (25.2% versus 21.3%; RR 1.2 [1.1 to 1.3], p < 0.001, NNH 26), compared to those with an NSAID claim only. Specifically, they had higher relative risk of fall/fracture (4.5% versus 3.4%; RR 1.3 [1.1 to 1.6], p = 0.002), nausea/vomiting (9.2% versus 7.3%; RR 1.3 [1.1 to 1.4], p < 0.001), and slowed colonic motility (8.0% versus 6.2%; RR 1.3 [1.1 to 1.4], p < 0.001). Risks of delirium, acute renal failure, and gastritis/duodenitis did not differ between groups. The main limitation of our study is the observational nature of the data and possibility of residual confounding. Conclusions Older adults filling an opioid prescription in the week after hospital discharge were at higher risk for mortality and other post-discharge adverse outcomes compared to those filling an NSAID prescription only.

Association of Primary Care Risk Mitigation Visits and Nonelective Emergency Department Visits in Patients Using Long-term Opioid Therapy

“…In accordance with other studies, our study found that falls or fall risk, 16 , 17 , 18 , 19 older age, 20 , 21 , 22 and use of behavioral health services 23 , 24 , 25 , 26 among LOT patients increased the odds of an NEDV. This further emphasizes the need to use risk assessment tools before refilling opioids in older patients, patients at high risk for falls, and those with comorbid depression or anxiety.…”

Ketoprofen as an emerging contaminant: occurrence, ecotoxicity and (bio)removal

“…Research is ongoing to study the efficacy of KTP for treating other animal species, leading to a wider application range of this drug ( Hu et al, 2021 ; Reynolds et al, 2021 ). In addition, the drug is being studied for its use as a safe alternative to opioid analgesics ( Doleman et al, 2021 ; Herzig et al, 2021 ; Pergolizzi et al, 2021 ). Thus, the volumes of production and consumption of KTP will only increase in the future.…”

Comparison of Preoperative Analgesics on the Efficacy of Inferior Alveolar Nerve Block with Patients Having Symptomatic Irreversible Pulpitis: A Double-Blinded, Randomized Controlled Trial

“…However, administering anaesthesia through a single technique eliminated possible confounders and enabled accurate evaluation of preoperative analgesic efficacy. Although Tramadol is clinically effective, it has been associated with more adverse effects than NSAIDs, particularly nausea and vomiting, limiting its frequent use ( 42 , 43 ). In contrast, NSAIDs have been reported to be less harmful and clinically more effective than opioids.…”