Underutilization of Acetaminophen in Older Adult Trauma Patients

Abstract

Introduction Older adults are more vulnerable to opioid-associated morbidity. The purpose of this study was to determine the frequency and timing of acetaminophen and opioid use in the postoperative period. Methods Older adult trauma patients (≥65 years) with hip fractures requiring femur or hip fixation were reviewed (Premier Database 2008-2014). We examined rates of acetaminophen use on the day of surgery and prior to receipt of oral opioids. Mixed-effects linear regression models were used to examine the effects of an acetaminophen-first approach on opioid use the day prior to and on the day of discharge. Results Of the 192 768 patients, 81.6% were Caucasian; 74.0% were female; and the mean age was 82.0 years [± 7.0]. Only 16.8% (32 291) of patients received acetaminophen prior to being prescribed opioids. 27.4% (52 779) received an acetaminophen-opioid combination, and 9.2% (17 730) received opioids without acetaminophen first. Acetaminophen first was associated with reduced opioid use on the day prior to and on the day of discharge (3.52 parenteral morphine equivalent doses (PMEs) less [95% CI: 3.33, 3.70]; P < .0001). A statistically but not clinically significant reduction in length of stay was observed in the acetaminophen-first group. Conclusion Nearly 37% of older adult patients did not receive acetaminophen as first-line analgesia after hip surgery. Multimodal analgesia, including non-opioid medications as first-line, should be encouraged.

Longitudinal associations of pain and cognitive decline in community-dwelling older adults.

“…Our findings suggest that pain management and prevention of pain incidence and persistence may help mitigate cognitive decline. Safe regimens include cognitive-behavioral interventions and exercise (Williams et al, 2020) as well as safe medications like acetaminophen (Haines et al, 2021) among others. Improving pain management is a worthwhile goal as older adults are often unscreened (34%) and undertreated (40%) despite being the most affected by pain in the population (Herr & Titler, 2009).…”

Letter re: “Underutilization of Acetaminophen in Older Adult Trauma Patients”

“…We found this publication by Dr Haines et al 1 to be a pertinent and informative read. The authors reported on the efficacy of an "acetaminophen first" protocol, which was associated with reduced opioid use leading up to discharge in older adult trauma patients-a population with a steady increase in opioid-related deaths throughout the past 20 years.…”

A Comparison of Postoperative Pain and Narcotic Prescriptions in Patients Undergoing Total Hip Arthroplasty Electively or for Femoral Neck Fracture

“…17 Previous studies have demonstrated that multimodal pain control significantly decreases the postoperative narcotic use in hip fracture surgery and provides more effective pain control. [18][19][20][21] While arthroplasty patients are also treated using this protocol, due to the higher incidence of preoperative narcotic use in this group, this model may be less effective in the elective arthroplasty patient population compared with the fracture population. Lastly, since elective THA patients presumably had higher preoperative pain due to chronic arthritis-related conditions, they would be expected to have less pain in the postoperative period than fracture patients.…”