Postsurgical Opioid Use Among Veterans Discharged to Skilled Care Facilities Compared to Veterans Discharged to Home After Orthopedic Surgery |
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| Affiliation: | 1. Department of Anesthesiology, George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, Salt Lake City, UT, USA;2. Department of Anesthesiology, University of Utah School of Medicine, Salt Lake City, UT, USA;3. Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, UT, USA;4. Division of Vascular Surgery, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA;1. Center for Excellence in Assisted Living (CEAL), Workforce & Quality Innovations, LLC, Bear Creek, NC, USA;2. Center for Excellence in Assisted Living (CEAL), Pioneer Network, Orlando, FL, USA;3. Center for Excellence in Assisted Living (CEAL), AMDA, The Society for Post-Acute and Long-Term Care Medicine, Columbia, MD, USA;4. Center for Excellence in Assisted Living (CEAL), American Assisted Living Nurses Association (AALNA), NAPA, CA, USA;5. Center for Excellence in Assisted Living (CEAL), ADvancing States, Arlington, VA, USA;6. Center for Excellence in Assisted Living (CEAL), Alzheimer’s Association, Washington, DC, USA;7. CLP Consulting, Bloomington, IN, USA;1. School of Aging Studies, University of South Florida, Tampa, FL, USA;2. Department of Ophthalmology, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA;1. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada;2. ICES, Toronto, Ontario, Canada;3. Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada;4. Bruyère Research Institute, Ottawa, Ontario, Canada;5. Schlegel Research Chair in Geriatric Medicine, Schlegel Research Institute for Aging, Waterloo, Ontario, Canada;6. School of Public Health Sciences, University of Waterloo, Ontario, Canada;1. Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy;2. Department of Cardiovascular, Endocrine-Metabolic Diseases and Aging, Istituto Superiore di Sanità, Rome, Italy;3. National Center for Global Health, Istituto Superiore di Sanità, Rome, Italy;4. Geriatrics Outpatient Clinic and Territorial Residences, Italian Hospital Group, Rome, Italy;5. ANASTE Humanitas Foundation, Rome, Italy;6. Geriatrics Unit, Department of Medicine, Campus Bio-Medico University and Teaching Hospital, Rome, Italy |
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| Abstract: | ObjectivesTo compare opioid use patterns among Veterans who were discharged to a skilled care facility vs home after orthopedic surgery at a VA hospital.DesignWe conducted a retrospective cohort study of Veterans who had orthopedic surgery at the Salt Lake City VA Medical Center (VAMC) between January 2018 and December 2021 and were followed by a transitional pain service. The principal outcome of interest was the time to stop opioid use after discharge from the hospital.Setting and ParticipantsVeterans not already on chronic opioid therapy who had orthopedic surgery at the Salt Lake City VAMC and were followed by a transitional pain service.Methods448 patients were included in the study, of which 371 (83%) were discharged to home and 77 (17%) were discharged to a skilled care facility. Median days to opioid cessation were estimated using the Kaplan-Meier method with 95% CIs and compared with discharge disposition using a log-rank test. Time to opioid cessation following hospital discharge was compared to baseline characteristics using univariable and multivariable Cox proportional hazards models.ResultsPatients who were discharged to a skilled care facility used opioids for twice as long as those who were discharged home [median days (interquartile range)]: 22 (19, 26) vs 11 (10, 12), P < .001, respectively. When controlling for baseline characteristics in the multivariable analysis, discharge to a skilled care facility was significantly associated with continued opioid use at all time points [hazard ratio 0.63 (95% CI 0.44, 0.89), P = .009].Conclusions and ImplicationsVeterans discharged to a skilled care facility after orthopedic surgery used opioids for twice as long as those who were discharged to home. As postsurgical pain management guidelines change to focus on nonopioid pain modalities and opioid reduction, skilled care providers should adapt those strategies for their facilities. |
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| Keywords: | Opioids extended care facility skilled nursing facility acute pain surgery |
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