Drug-related challenges following primary total hip and knee arthroplasty

Basic Clin Pharmacol Toxicol. 2021 Aug;129(2):139-147. doi: 10.1111/bcpt.13616. Epub 2021 Jun 9.

Abstract

We aimed to characterize the in-hospital analgesic use among total hip or knee arthroplasty (THA or TKA) patients, and to identify possible drug-related challenges. We identified 15 263 patients operated with a THA or TKA between 1 January 2012 and 30 April 2016. The prevalence of analgesic users and patients with potential clinically relevant drug-drug interactions (DDIs), along with the prevalence of readmission among patients with vs. without a DDI, were calculated. A DDI was defined as the combination of (A) a diuretic, an angiotensin-converting enzyme inhibitor or an angiotensin II receptor blocker, and an non-steroidal anti-inflammatory Drug (NSAID); (B) warfarin and an NSAID; and (C) a benzodiazepine or a benzodiazepine-related drug and an opioid. The prevalence of analgesics administered in THA and TKA patients was 99.3% and 99.1% for paracetamol and 93.8% and 98.8% for opioids, respectively. The prevalence of patients who received interaction A, B or C was 8.4%, 2.5% and 40.7%, respectively. Patients with vs. without a DDI had a higher prevalence of 30-day readmission. In conclusion, most THA and TKA patients were administered paracetamol or opioids. The prevalence of 30-day readmission was higher in patients with than in patients without a potential clinically relevant DDI.

Keywords: analgesic drugs; drug interactions; inappropriate prescriptions; total hip replacement; total knee replacement.

MeSH terms

  • Acetaminophen / therapeutic use
  • Adult
  • Aged
  • Aged, 80 and over
  • Analgesics / therapeutic use*
  • Analgesics, Opioid / therapeutic use
  • Angiotensins / antagonists & inhibitors
  • Arthroplasty, Replacement, Hip / adverse effects*
  • Arthroplasty, Replacement, Hip / statistics & numerical data*
  • Arthroplasty, Replacement, Knee / adverse effects*
  • Arthroplasty, Replacement, Knee / statistics & numerical data*
  • Diuretics / therapeutic use
  • Drug Interactions
  • Female
  • Hospitals
  • Humans
  • Male
  • Middle Aged
  • Patient Readmission
  • Postoperative Complications
  • Risk Factors
  • Warfarin / therapeutic use

Substances

  • Analgesics
  • Analgesics, Opioid
  • Angiotensins
  • Diuretics
  • Acetaminophen
  • Warfarin