Available online 21 March 2023

Nonsteroidal anti-inflammatory drugs (NSAIDs) are indicated for post-operative pain management, but use may be precluded by report of adverse drug reactions (ADRs). The effect of NSAID ADR labeling on opioid prescribing following total joint arthroplasty (TJA) is unknown.

To assess the association between NSAID ADRs and post-operative opioid prescribing following TJA, a common surgical procedure.

We performed a retrospective cohort study of adults undergoing total joint (knee or hip) replacement in a single hospital network between 4/1/2016-12/31/2019. Demographic information, clinical and surgical characteristics, and prescription data were obtained from the electronic health record. We studied the association between reported NSAID ADRs and post-operative opioid prescribing in a propensity score-matched sample over one year of follow-up.

NSAID ADRs were reported by 9.6% of the entire cohort (n=584/6,091). NSAID ADR was associated with 41% higher odds of receipt of opioid prescriptions at 181-365 days following hospital discharge (95% confidence interval 13%-75%) in a propensity score-matched sample. Over 98% of individuals received an opioid prescription at time of hospital discharge, with no difference in overall median opioid dose prescribed by NSAID ADR status. However, more patients with NSAID ADRs (7.6% vs 4.7%) received cumulative opioid doses ≥750 morphine milligram equivalents (MME) at discharge (p=0.004).

Reported NSAID ADR was associated with increased risk for prolonged receipt of opioids at 181-365 days post-operatively. Patients with NSAID ADRs more frequently received cumulative opioid doses ≥750 MME at discharge following TJA. Clarification and evaluation of reported NSAID ADRs may be particularly beneficial for surgical patients at high risk for prolonged receipt of opioids.

© 2023 Published by Elsevier Inc. on behalf of the American Academy of Allergy, Asthma & Immunology