Underutilization of Acetaminophen in Older Adult Trauma Patients

• Published in: The American surgeon 2022-08, Vol.88 (8), p.2003-2010
• Main Authors: Haines, Krista L., Fuller, Matthew, Antonescu, Ioana, Vaughan, Justin G., Raghunathan, Karthik, Cox, Christopher E., Bartz, Raquel R., Ohnuma, Tetsu, Agarwal, Suresh, Krishnamoorthy, Vijay
• Format: Article
• Language: English
• Subjects: Acetaminophen; Analgesia; Analgesics; Chronic obstructive pulmonary disease; Closed reduction; Demographics; Diabetes; Drug abuse; Drug dosages; Femur; Fibromyalgia; Fractures; Heart failure; Hip; Length of stay; Liver diseases; Medicare; Morbidity; Morphine; Narcotics; Nonsteroidal anti-inflammatory drugs; Older people; Opioids; Pain management; Pain perception; Patients; Regression analysis; Regression models; Rheumatoid arthritis; Statistical analysis; Surgery; Trauma; Trends
• ISSN: 0003-1348; 1555-9823
• DOI: 10.1177/00031348211023397

Introduction Older adults are more vulnerable to opioid-associated morbidity. The purpose of this study was to determine the frequency and timing of acetaminophen and opioid use in the postoperative period. Methods Older adult trauma patients (≥65 years) with hip fractures requiring femur or hip fixation were reviewed (Premier Database 2008-2014). We examined rates of acetaminophen use on the day of surgery and prior to receipt of oral opioids. Mixed-effects linear regression models were used to examine the effects of an acetaminophen-first approach on opioid use the day prior to and on the day of discharge. Results Of the 192 768 patients, 81.6% were Caucasian; 74.0% were female; and the mean age was 82.0 years [± 7.0]. Only 16.8% (32 291) of patients received acetaminophen prior to being prescribed opioids. 27.4% (52 779) received an acetaminophen-opioid combination, and 9.2% (17 730) received opioids without acetaminophen first. Acetaminophen first was associated with reduced opioid use on the day prior to and on the day of discharge (3.52 parenteral morphine equivalent doses (PMEs) less [95% CI: 3.33, 3.70]; P < .0001). A statistically but not clinically significant reduction in length of stay was observed in the acetaminophen-first group. Conclusion Nearly 37% of older adult patients did not receive acetaminophen as first-line analgesia after hip surgery. Multimodal analgesia, including non-opioid medications as first-line, should be encouraged.