Title: Persistent opioid use and incidence of serious opioid-related harms in new-users following musculoskeletal surgery
Funder: Versus Arthritis

Abstract: Background Opioid use and related adverse outcomes have reached epidemic proportions in the US, Canada and world-wide with rising trends nationally. Post-surgical pain and its’ treatment with opioids, is an important consideration for the 200 million patients who undergo surgery worldwide. Patients who undergo surgeries for musculoskeletal indications maybe particularly vulnerable to experiencing opioid-related harms due to older age, multimorbidity and polypharmacy. Some may be prescribed high-strength opioids when not required, for longer than necessary or may develop long-term persistent opioid use, which is associated with risks of injury and adverse outcomes. Aim The overall aim is to assess the association between prescribing patterns, persistent opioid use and consequences of opioid use in new users following orthopaedic vs. major surgery Objectives To evaluate opioid prescribing according to levels of patient reported post-operative pain during inpatient admissions and at discharge To identify opioid prescribing patterns and subgroups of patients at risk of persistent opioid use (defined as ≥1 opioid prescription 3 months after surgery) To assess the incidence and risk factors for opioid-related harms up to 1-year post-surgery Methods Secondary care electronic health records (EHR) from Salford Royal NHS Foundation trust (a Global Digital Exemplar site) will be linked to intermediate and primary care data. This EHR benefits from an electronic prescribing system that captures both prescriptions and administered medications, to accurately define exposure. Patient reported pain is collected longitudinally during admission to allow assessment of appropriate opioid use. Baseline information (such as Waterlow scores and electronic Frailty Index) collected as part of routine care will allow better control for confounding, giving a clearer picture of causal associations. Relevance to Versus Arthritis This proposal aligns with Versus Arthritis’ vision for a research community to better manage, treat and prevent pain. Post-surgical pain affects millions of patients, and a large proportion of them are started on opioids given limited analgesic options. By stratification of patients most likely to develop persistent use and opioid related harms, early interventions could be implemented to personalise pain management and care. This proposal explores the research roadmap priorities of harnessing ehealth linked data to address an important clinical and public health concern in chronic pain. Using routinely-collected data we have the opportunity to examine the relationship between comorbidities, under-represented and hard to reach groups as risk factors on key outcomes to enable development of future interventions and better, safer patient care. Potential patient benefit Patients and clinicians face an important challenge in attempting to balance the benefits and harms of adequately managing postoperative pain and development of persistent opioid use. An important barrier to overcome this challenge is the current limited understanding of risk factors and long-term risks associated with persistent opioid use. Identification of subgroups most vulnerable to opioid-related harms and persistent use would allow future development of targeted interventions in both primary/secondary care, whilst avoiding depriving the entire population of this class of drugs that may be effective for some.


Research activity codes: 7.3 MANAGEMENT AND DECISION MAKING
Health categories: CANCER AND NEOPLASMS;MUSCULOSKELETAL