• Ellen M Soffin, Lauren A Wilson, Jiabin Liu, Jashvant Poeran, and Stavros G Memtsoudis.
• Department of Anesthesiology, Critical Care and Pain Management, Hospital for Special Surgery, New York, NY, USA; Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA. Electronic address: soffine@hss.edu.
• Br J Anaesth. 2021 Jun 1; 126 (6): 1217-1225.

BackgroundScarce data exist on differential opioid prescribing between men and women in the pre-, peri-, and postoperative phases of care among patients undergoing total hip/knee arthroplasty (THA/TKA).MethodsIn this retrospective population-based study, Truven Health MarketScan claims data were used to establish differences between men and women in (1) opioid prescribing in the year before THA/TKA surgery, (2) the amount of opioids prescribed at discharge, and (3) chronic opioid prescribing (3-12 months after surgery). Multivariable regression models measured odds ratios (OR) with 95% confidence intervals (95% CI).ResultsAmong 29 038 THAs (42% men) and 48 523 TKAs (52% men) men (compared with women) were less likely to receive an opioid prescription in the year before surgery (54% vs 60%, and 54% vs 60% for THA and TKA, respectively); P<0.001. However, in multivariable analyses male sex was associated with higher total opioid dosages prescribed at discharge after THA (OR=1.04; 95% CI 1.03, 1.06) and TKA (OR=1.05; 95% CI 1.04, 1.06); both P<0.001. Chronic opioid prescribing was found in 10% of the cohort (THA: n=2333; TKA: n=5365). Here, men demonstrated lower odds of persistent opioid prescribing specifically after THA (OR=0.90; 95% CI 0.82, 0.99) but not TKA (OR=0.96; 95% CI 0.90, 1.02); P=0.026 and P=0.207, respectively.ConclusionsWe found sex-based differences in opioid prescribing across all phases of care for THA/TKA. The results highlight temporal opportunities for targeted interventions to improve outcomes after total joint arthroplasty, particularly for women, and to decrease chronic opioid prescribing.Copyright © 2021 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.

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