Do sex, age, and comorbidities modify the association of socioeconomic status and opioid use after total hip arthroplasty?: a population-based study from the Danish Hip Arthroplasty Register.

BACKGROUND AND PURPOSE: We aimed to examine the association between socioeconomic status (SES) markers and opioid use after primary total hip arthroplasty (THA) due to osteoarthritis, and whether sex, age, or comorbidities modify any association. METHODS: Using Danish databases, we included 80,038 patients undergoing primary THA (2001-2018). We calculated prevalences and prevalence ratios (PRs with 95% confidence intervals [CIs]) of immediate post-THA opioid use (≥ 1 prescription within 1 month) and continued opioid use (≥ 1 prescription in 1-12 months) among immediate opioid users. Exposures were individual-based education, cohabitation, and wealth. RESULTS: The prevalence of immediate opioid use was ~45% in preoperative non-users and ~60% in preoperative users (≥ 1 opioid 0-6 months before THA). Among non-users, the prevalences and PRs of continued opioid use were: 28% for low vs. 21% for high education (PR 1.28, CI 1.20-1.37), 27% for living alone vs. 23% for cohabiting (PR 1.09, CI 1.04-1.15), and 30% for low vs. 20% for high wealth (PR 1.43, CI 1.35-1.51). Among users, prevalences were 67% for low vs. 55% for high education (1.22, CI 1.17-1.27), 68% for living alone vs. 60% for cohabiting (PR 1.10, CI 1.07-1.12), and 73% for low wealth vs. 54% for high wealth (PR 1.32, CI 1.28-1.36). Based on testing for interaction, sex, age, and comorbidity did not statistically significant modify the associations. Nevertheless, associations were stronger in younger patients for all SES markers (mainly for non-users). CONCLUSION: Markers of low SES were associated with a higher prevalence of continued post-THA opioid use. Age modified the magnitude of the associations, but it was not statistically significant.

Multimorbidity measured with Charlson Comorbidity Index is not associated with clinically relevant risk of revision after primary total hip arthroplasty: a population-based cohort study on 98,647 patients from the Danish Hip Arthroplasty Register.

BACKGROUND AND PURPOSE: Evidence for guiding healthcare professionals on the risks of total hip arthroplasty (THA) in multimorbid patients is sparse. We aimed to examine the association between multimorbidity and the risk of revision due to any cause and specific causes after primary THA due to osteoarthritis. PATIENTS AND METHODS: We identified 98,647 THA patients and subsequent revisions in the Danish Hip Arthroplasty Register from 1995 to 2018. Multimorbidity was measured with the Charlson Comorbidity Index (CCI). Using the CCI (low, medium, high), we calculated the cumulative incidence function (CIF) of first revision up to 10 years after THA. Adjusted cause-specific hazard ratios (aHRs) were estimated using Cox regressions. All estimates are presented with 95% confidence intervals (CI). RESULTS: Overall, the prevalence of patients with low, medium, and high CCI was 70%, 24%, and 6%. The CIF of any revision within 10 years was 6.5% (CI 6.2-6.7) in low and 6.5% (CI 5.8-7.3) in high CCI, with an aHR of 1.4 (CI 1.2-1.6) for patients with high compared with low CCI. The corresponding aHRs for cause-specific revision were 1.3 (CI 1.0-1.6) for aseptic loosening within 10 years, 1.2 (CI 0.9-1.6) for infection, and 1.7 (CI 1.3-2.2) for dislocation, both within 2 years. CONCLUSION: Multimorbidity is associated with a minor but not clinically relevant increased risk of revision up to 10 years after primary THA.

Sex and age differences in the use of analgesic drugs before and after primary total hip arthroplasty in 105,520 Danish patients.

BACKGROUND: We examined analgesic drug use before and after total hip arthroplasty (THA) by sex and age, and impact of comorbidity in that context. METHODS: Using Danish nationwide medical registries, we included 105,520 THA patients (1996-2018). We calculated prevalence of overall analgesic drug use and use of NSAIDs and opioids separately in four quarters before (-Q4 to -Q1) and after THA (Q1 to Q4). -Q4 and Q4 was compared using prevalence rate ratios (PRR) with 95% confidence interval (CI). RESULTS: Among women, analgesic drug use was 46% in -Q4, 65% in Q1, but decreased to 31% in Q4 (PRR: 0.68 (CI: 0.67-0.69)). Among men, these numbers were 39% in -Q4, 62% in Q1, and 23% in Q4 (PRR: 0.61 (CI: 0.60-0.63)). Analgesic drug use was higher among older patients in all quarters except Q1. Analgesic drug use decreased from 40% in -Q4 to 25% in Q4 (PRR: 0.62 (CI: 0.59-0.64)) in patients <55 years, and from 44% to 30% in patients >85 years, (PRR: 0.67 (CI: 0.63-0.71)). Women used more NSAIDs and opioids than men. Older patients used more opioids compared to younger, while variation in NSAID use by age was small. Decrease in analgesic drug use from -Q4 to Q4 was least pronounced in patients with comorbidity history. CONCLUSIONS: Women and older patients have higher prevalence of analgesic drug use before and after THA, and a smallest reduction in analgesic drug use from before to after THA. Comorbidity history modified these associations.