{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T20:25:28Z","timestamp":1793651128409,"version":"4.5.1"},"update-to":[{"DOI":"10.1371\/journal.pmed.1003804","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2021,10,11]],"date-time":"2021-10-11T00:00:00Z","timestamp":1633910400000}}],"reference-count":28,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2021,9,27]],"date-time":"2021-09-27T00:00:00Z","timestamp":1632700800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000133","name":"Agency for Healthcare Research and Quality","doi-asserted-by":"publisher","award":["R01HS026215"],"award-info":[{"award-number":["R01HS026215"]}],"id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosmedicine.org"],"crossmark-restriction":false},"short-container-title":["PLoS Med"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Although analgesics are initiated on hospital discharge in millions of adults each year, studies quantifying the risks of opioids and nonsteroidal anti-inflammatory drugs (NSAIDs) among older adults during this transition are limited. We sought to determine the incidence and risk of post-discharge adverse events among older adults with an opioid claim in the week after hospital discharge, compared to those with NSAID claims only.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods and findings<\/jats:title>\n<jats:p>We performed a retrospective cohort study using a national sample of Medicare beneficiaries age 65 and older, hospitalized in United States hospitals in 2016. We excluded beneficiaries admitted from or discharged to a facility. We derived a propensity score that included over 100 factors potentially related to the choice of analgesic, including demographics, diagnoses, surgeries, and medication coadministrations. Using 3:1 propensity matching, beneficiaries with an opioid claim in the week after hospital discharge (with or without NSAID claims) were matched to beneficiaries with an NSAID claim only. Primary outcomes included death, healthcare utilization (emergency department [ED] visits and rehospitalization), and a composite of known adverse effects of opioids or NSAIDs (fall\/fracture, delirium, nausea\/vomiting, complications of slowed colonic motility, acute renal failure, and gastritis\/duodenitis) within 30 days of discharge. After propensity matching, there were 13,385 beneficiaries in the opioid cohort and 4,677 in the NSAID cohort (mean age: 74 years, 57% female). Beneficiaries receiving opioids had a higher incidence of death (1.8% versus 1.1%; relative risk [RR] 1.7 [1.3 to 2.3], <jats:italic>p<\/jats:italic> &lt; 0.001, number needed to harm [NNH] 125), healthcare utilization (19.0% versus 17.4%; RR 1.1 [1.02 to 1.2], <jats:italic>p<\/jats:italic> = 0.02, NNH 59), and any potential adverse effect (25.2% versus 21.3%; RR 1.2 [1.1 to 1.3], <jats:italic>p<\/jats:italic> &lt; 0.001, NNH 26), compared to those with an NSAID claim only. Specifically, they had higher relative risk of fall\/fracture (4.5% versus 3.4%; RR 1.3 [1.1 to 1.6], <jats:italic>p<\/jats:italic> = 0.002), nausea\/vomiting (9.2% versus 7.3%; RR 1.3 [1.1 to 1.4], <jats:italic>p<\/jats:italic> &lt; 0.001), and slowed colonic motility (8.0% versus 6.2%; RR 1.3 [1.1 to 1.4], <jats:italic>p<\/jats:italic> &lt; 0.001). Risks of delirium, acute renal failure, and gastritis\/duodenitis did not differ between groups. The main limitation of our study is the observational nature of the data and possibility of residual confounding.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Older adults filling an opioid prescription in the week after hospital discharge were at higher risk for mortality and other post-discharge adverse outcomes compared to those filling an NSAID prescription only.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pmed.1003804","type":"journal-article","created":{"date-parts":[[2021,9,27]],"date-time":"2021-09-27T19:42:25Z","timestamp":1632771745000},"page":"e1003804","update-policy":"https:\/\/doi.org\/10.1371\/journal.pmed.corrections_policy","source":"Crossref","is-referenced-by-count":29,"title":["Relative risks of adverse events among older adults receiving opioids versus NSAIDs after hospital discharge: A nationwide cohort study"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8005-4727","authenticated-orcid":true,"given":"Shoshana J.","family":"Herzig","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5384-275X","authenticated-orcid":true,"given":"Timothy S.","family":"Anderson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoojin","family":"Jung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Long","family":"Ngo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7290-6838","authenticated-orcid":true,"given":"Dae H.","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1705-6249","authenticated-orcid":true,"given":"Ellen P.","family":"McCarthy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,9,27]]},"reference":[{"issue":"5","key":"pmed.1003804.ref001","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1016\/j.ejpain.2004.09.010","article-title":"Pain prevalence and predictors among inpatients in a major Italian teaching hospital. A baseline survey towards a pain free hospital","volume":"9","author":"RM Melotti","year":"2005","journal-title":"Eur J Pain"},{"issue":"3","key":"pmed.1003804.ref002","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1016\/j.pmn.2008.02.001","article-title":"Pain prevalence study in a large Canadian teaching hospital","volume":"9","author":"J Sawyer","year":"2008","journal-title":"Pain Manag Nurs"},{"issue":"2","key":"pmed.1003804.ref003","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1002\/jhm.2102","article-title":"Opioid utilization and opioid-related adverse events in nonsurgical patients in US hospitals","volume":"9","author":"SJ Herzig","year":"2014","journal-title":"J Hosp Med"},{"issue":"4","key":"pmed.1003804.ref004","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1002\/phar.1223","article-title":"Cost and quality implications of opioid-based postsurgical pain control using administrative claims data from a large health system: opioid-related 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Epidemiol"},{"issue":"5","key":"pmed.1003804.ref018","doi-asserted-by":"crossref","first-page":"e45","DOI":"10.1097\/EDE.0000000000000864","article-title":"Web Site and R Package for Computing E-values","volume":"29","author":"MB Mathur","year":"2018","journal-title":"Epidemiology"},{"issue":"4","key":"pmed.1003804.ref019","doi-asserted-by":"crossref","first-page":"268","DOI":"10.7326\/M16-2607","article-title":"Sensitivity Analysis in Observational Research: Introducing the E-Value","volume":"167","author":"TJ VanderWeele","year":"2017","journal-title":"Ann Intern Med"},{"issue":"17","key":"pmed.1003804.ref020","doi-asserted-by":"crossref","first-page":"1661","DOI":"10.1001\/jama.2017.16190","article-title":"Effect of a Single Dose of Oral Opioid and Nonopioid Analgesics on Acute Extremity Pain in the Emergency Department: A Randomized Clinical Trial","volume":"318","author":"AK Chang","year":"2017","journal-title":"JAMA"},{"issue":"2","key":"pmed.1003804.ref021","first-page":"CD004137","article-title":"Nonsteroidal anti-inflammatory drugs (NSAIDs) versus opioids for acute renal colic","author":"A Holdgate","year":"2005","journal-title":"Cochrane Database Syst Rev"},{"issue":"9","key":"pmed.1003804.ref022","first-page":"CD008659","article-title":"Single dose oral analgesics for acute postoperative pain in adults\u2014an overview of Cochrane reviews","author":"RA Moore","year":"2015","journal-title":"Cochrane Database Syst Rev"},{"issue":"8","key":"pmed.1003804.ref023","first-page":"Cd007789","article-title":"Oral non-steroidal anti-inflammatory drugs versus other oral analgesic agents for acute soft tissue injury","volume":"8","author":"P Jones","year":"2020","journal-title":"Cochrane Database Syst Rev"},{"key":"pmed.1003804.ref024","first-page":"CD011407","article-title":"Adverse events associated with single dose oral analgesics for acute postoperative pain 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