TY - JOUR
T1 - Pain Reporting, Opiate Dosing, and the Adverse Effects of Opiates After Hip or Knee Replacement in Patients 60 Years Old or Older
AU - Petre, Benjamin M.
AU - Roxbury, Christopher R.
AU - McCallum, Jeremy R.
AU - Defontes, Kenneth W.
AU - Belkoff, Stephen M.
AU - Mears, Simon C.
PY - 2012/3
Y1 - 2012/3
N2 - Our goal was to determine whether there were age-related differences in pain, opiate use, and opiate side effects after total hip or knee arthroplasty in patients 60 years old or older. We hypothesized that there would be no significant differences between age groups in (1) mean pain score, (2) opiate use after adjusting for pain, or (3) opiate side effects after adjusting for opiate use and pain score. We retrospectively reviewed the electronic and paper charts of all patients undergoing total joint replacements at our institution over 3 years who met the following criteria: (1) 60 years old or older, (2) primary single total knee or total hip replacement, and (3) no preoperative dementia. Preoperative, intraoperative, and postoperative course data were collected using a customized data entry process and database. We divided the patients into 2 age groups, those 60 to 79 years old and those 80 years old or older. Using a marginal model with the panel variable of postoperative day, we investigated the associations between age group and pain, age group and pain adjusting for opiate use, and age group and complications (respiratory depression, naloxone usage as a measure of respiratory arrest, delirium, constipation, and urinary retention) adjusting for opiate use (Xtgee, Stata10, Stata Corp. LP, College Station, Texas). Significance was set at P < .05. We found no significant difference in pain scores between groups, but the older group had significantly fewer opiates prescribed yet significantly more side effects, including delirium (odds ratio 4.2), than did the younger group, even after adjusting for opiate dose and pain score.
AB - Our goal was to determine whether there were age-related differences in pain, opiate use, and opiate side effects after total hip or knee arthroplasty in patients 60 years old or older. We hypothesized that there would be no significant differences between age groups in (1) mean pain score, (2) opiate use after adjusting for pain, or (3) opiate side effects after adjusting for opiate use and pain score. We retrospectively reviewed the electronic and paper charts of all patients undergoing total joint replacements at our institution over 3 years who met the following criteria: (1) 60 years old or older, (2) primary single total knee or total hip replacement, and (3) no preoperative dementia. Preoperative, intraoperative, and postoperative course data were collected using a customized data entry process and database. We divided the patients into 2 age groups, those 60 to 79 years old and those 80 years old or older. Using a marginal model with the panel variable of postoperative day, we investigated the associations between age group and pain, age group and pain adjusting for opiate use, and age group and complications (respiratory depression, naloxone usage as a measure of respiratory arrest, delirium, constipation, and urinary retention) adjusting for opiate use (Xtgee, Stata10, Stata Corp. LP, College Station, Texas). Significance was set at P < .05. We found no significant difference in pain scores between groups, but the older group had significantly fewer opiates prescribed yet significantly more side effects, including delirium (odds ratio 4.2), than did the younger group, even after adjusting for opiate dose and pain score.
KW - elderly
KW - hip replacement
KW - knee replacement
KW - opiates
KW - pain
UR - http://www.scopus.com/inward/record.url?scp=84993682734&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84993682734&partnerID=8YFLogxK
U2 - 10.1177/2151458511432758
DO - 10.1177/2151458511432758
M3 - Article
C2 - 23569691
AN - SCOPUS:84993682734
SN - 2151-4585
VL - 3
SP - 3
EP - 7
JO - Geriatric Orthopaedic Surgery & Rehabilitation
JF - Geriatric Orthopaedic Surgery & Rehabilitation
IS - 1
ER -