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Impact of COVID-19 on opioid use in those awaiting hip and knee arthroplasty: a retrospective cohort study
  1. Luke Farrow1,2,
  2. William T Gardner1,2,
  3. Chee Chee Tang2,
  4. Rachel Low1,
  5. Patrice Forget1,2,
  6. George Patrick Ashcroft1,2
  1. 1 Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
  2. 2 Trauma & Orthopaedics, Woodend Hospital, Aberdeen, UK
  1. Correspondence to Luke Farrow, University of Aberdeen, Aberdeen AB24 3FX, UK; luke.farrow{at}


Background COVID-19 has had a detrimental impact on access to hip and knee arthroplasty surgery. We set out to examine whether this had a subsequent impact on preoperative opioid prescribing rates for those awaiting surgery.

Methods Data regarding patient demographics and opioid utilisation were collected from the electronic health records of included patients at a large university teaching hospital. Patients on the outpatient waiting list for primary hip and knee arthroplasty as of September 2020 (COVID-19 group) were compared with historical controls (Controls) who had previously undergone surgery. A sample size calculation indicated 452 patients were required to detect a 15% difference in opioid prescription rates between groups.

Results A total of 548 patients (58.2% female) were included, 260 in the COVID-19 group and 288 in the Controls. Baseline demographics were similar between the groups. For those with data available, the proportion of patients on any opioid at follow-up in the COVID-19 group was significantly higher: 55.0% (143/260) compared with 41.2% (112/272) in the Controls (p=0.002). This remained significant when adjusted for confounding (age, gender, Scottish Index of Multiple Deprivation, procedure and wait time). The proportion of patients on a strong opioid was similar (4.2% (11/260) vs 4.8% (13/272)) for COVID-19 and Controls, respectively. The median waiting time from referral to follow-up was significantly longer in the COVID-19 group compared with the Controls (455 days vs 365 days; p<0.0001).

Conclusion The work provides evidence of potential for an emerging opioid problem associated with the influence of COVID-19 on elective arthroplasty services. Viable alternatives to opioid analgesia for those with end-stage arthritis should be explored, and prolonged waiting times for surgery ought to be avoided in the recovery from COVID-19 to prevent more widespread opioid use.

  • COVID-19
  • pharmacoepidemiology
  • surgery

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Data are available upon reasonable request. Aggregated anonymised data is available on request.

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Data availability statement

Data are available upon reasonable request. Aggregated anonymised data is available on request.

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  • Contributors LF: Research idea development, data acquisition, data analysis, results interpretation and drafting/revision of the paper. He is the guarantor. WTG: Research idea development, data acquisition, drafting/revision of the paper. CCT: Data acquisition, drafting/revision of the paper. RL: Data acquisition, drafting/revision of the paper. PF: Research idea development, results interpretation, drafting/revision of the paper. GPA: Research idea development, results interpretation and drafting/revision of the paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.