Persistent postoperative opioid use in patients treated with total hip arthroplasty and hemiarthroplasty for femoral neck fracture: a propensity-score-matched analysis.

Background: Pain management after hip fracture surgery is particularly challenging because clinicians must simultaneously minimize prolonged opioid exposure while ensuring effective recovery in this vulnerable patient population. We sought to compare persistent postoperative opioid use across a matched group of patients with femoral neck fracture treated with either total hip arthroplasty (THA) or hemiarthroplasty and to describe the association between patient characteristics and opioid use.

Methods: Routinely collected health care databases were linked at ICES to create a population-based cohort of patients aged 66 years or older in Ontario, Canada, who underwent THA or hemiarthroplasty for a femoral neck fracture between 2002 and 2016. We used propensity-score matching to balance potential confounders. We quantified and compared persistent postoperative opioid use between treatment groups using survival analysis.

Results: The full cohort consisted of 45 119 patients, of whom 41 247 (91.4%) were treated with hemiarthroplasty and 3872 (8.6%) were treated with THA. More than half (n = 25 168, 55.8%) of patients had not filled an opioid prescription in the year before hip fracture and were considered naive to opioids. Overall, 5958 (23.7%) opioid-naive patients filled at least 1 opioid prescription between 90 days and 1 year after hip fracture. All eligible patients who underwent THA were matched 1:2 to hemiarthroplasty patients (matched cohort n = 6492). There was no statistically significant difference in persistent postoperative opioid use between treatment groups (relative risk 1.06, 95% confidence interval 0.96 to 1.17). Patients living in long-term care or requiring home care services and patients with a high comorbidity burden were more likely to use opioid medication, before and after hip fracture.

Conclusion: Persistent opioid use is common after both THA and hemiarthroplasty for hip fracture. Patients with higher health care needs before fracture and higher comorbidity burden were more likely to persistently use postoperative opioids.