{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T23:22:37Z","timestamp":1788996157029,"version":"build-2803163510"},"reference-count":45,"publisher":"MJS Publishing, Medical Journals Sweden AB","license":[{"start":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T00:00:00Z","timestamp":1760054400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["ActaO"],"abstract":"<jats:p>Background and purpose:\u00a0Concurrent benzodiazepine\u2013opioid use is discouraged. We aimed to examine trajectories of benzodiazepine, opioid, and concurrent use following hip and knee arthroplasties for osteoarthritis (HA-OA, KA) and hip arthroplasty for fracture (HA-fracture).Methods:\u00a0In this nationwide cohort study, the Dutch Arthroplasty Register (LROI) was linked to the Dutch Foundation for Pharmaceutical Statistics (SFK). We evaluated the proportion of patients with \u2265 1 medication dispensation in the year pre- and post-procedure and the prescribing physicians. Concurrent use was defined as \u2265 7 days overlap of benzodiazepine and opioid exposure.Results:\u00a0We included 109,238 HA-OA, 17,464 HA fracture, and 113,306 KA. Between 2013 and 2021, the risk difference of postoperative benzodiazepine use was \u20137.2% (95% confidence interval [CI] \u20138.1 to \u20136.2%), while postoperative opioid use increased by 29.7% (CI 28.5\u201330.8%). Among HA-OA, from 2013 (4,391 arthroplasties) to 2021 (12,905 arthroplasties), the percentage of preoperative benzodiazepine users went from 18% to 13%, and postoperative from 23% to 14%. In contrast, preoperative opioid use changed from 25% to 33% and postoperative from 36% to 69%, In 2021, 6% of HA-OA, 11% of HA fracture, and 9% of KA received a concurrent dispensation in the first post-procedure year, predominantly in the first quarter. Orthopedic surgeons prescribed 29% (~18,732 prescriptions) of initial concurrent dispensations; subsequent prescriptions were mainly from general practitioners.Conclusion:\u00a0From 2013\u20132022 in the Netherlands, benzodiazepine use decreased while opioid use increased among arthroplasty patients. Concurrent use remained frequent, despite safety recommendations against co-prescribing.<\/jats:p>","DOI":"10.2340\/17453674.2025.44755","type":"journal-article","created":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T07:41:33Z","timestamp":1760082093000},"source":"Crossref","is-referenced-by-count":3,"title":["10-year trends in benzodiazepine, opioid, and concurrent use in hip and knee arthroplasty: a nationwide cohort study from the Netherlands"],"prefix":"10.2340","volume":"96","author":[{"given":"Manuela","family":"Yepes-Calder\u00f3n","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1228-4162","authenticated-orcid":false,"given":"Rob G H H","family":"Nelissen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcel L","family":"Bouvy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frits L","family":"Rosendaal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8141-842X","authenticated-orcid":false,"given":"Liza N","family":"Van Steenbergen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Albert","family":"Dahan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6106-3385","authenticated-orcid":false,"given":"Maaike G J","family":"Gademan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1183","published-online":{"date-parts":[[2025,10,10]]},"reference":[{"key":"129342","doi-asserted-by":"crossref","unstructured":"Thaler M, Khosravi I, Hirschmann M T, Kort N P, Zagra L, Epinette J A, et al. Disruption of joint arthroplasty services in Europe during the COVID-19 pandemic: an online survey within the European Hip Society (EHS) and the European Knee Associates (EKA). Knee Surg Sports Traumatol Arthrosc 2020; 28(6): 1712-19. doi: 10.1007\/s00167-020-06033-1.","DOI":"10.1007\/s00167-020-06033-1"},{"key":"129343","doi-asserted-by":"crossref","unstructured":"Worlicek M, Koch M, Daniel P, Freigang V, Angele P, Alt V, et al. A retrospective analysis of trends in primary knee arthroplasty in Germany from 2008 to 2018. Sci Rep 2021; 11(1): 5225. doi: 10.1038\/s41598-021-84710-y.","DOI":"10.1038\/s41598-021-84710-y"},{"key":"129344","doi-asserted-by":"crossref","unstructured":"Van Brug H E, Nelissen R G H H, Lijfering W M, Van Steenbergen L N, Rosendaal F R, Van Dorp E L A, et al. Opioid prescribing patterns after arthroplasty of the knee and hip: a Dutch nationwide cohort study from 2013 to 2018. Acta Orthop 2022; 93: 667-81. doi: 10.2340\/17453674.2022.3993.","DOI":"10.2340\/17453674.2022.3993"},{"key":"129345","doi-asserted-by":"crossref","unstructured":"Lembke A, Papac J, Humphreys K. Our other prescription drug problem. N Engl J Med 2018; 378(8): 693-5. doi: 10.1056\/NEJMp1715050.","DOI":"10.1056\/NEJMp1715050"},{"key":"129346","doi-asserted-by":"crossref","unstructured":"Dong J Y, Ju J H, Yang Y M. Analysis of the prescription trends of potentially inappropriate medications in Korean older outpatients by sex: a retrospective study using data from the health insurance review and assessment service. Medicine (Baltimore) 2023; 102(34): e34818. doi: 10.1097\/MD.0000000000034818.","DOI":"10.1097\/MD.0000000000034818"},{"key":"129347","doi-asserted-by":"crossref","unstructured":"Diaz-Gutierrez M J, Martinez-Cengotitabengoa M, Saez de Adana E, Cano A I, Martinez-Cengotitabengoa M T, Besga A, et al. Relationship between the use of benzodiazepines and falls in older adults: a systematic review. Maturitas 2017; 101: 17-22. doi: 10.1016\/j.maturitas.2017.04.002.","DOI":"10.1016\/j.maturitas.2017.04.002"},{"key":"129348","doi-asserted-by":"crossref","unstructured":"Hernandez N M, Cunningham D J, Hinton Z W, Wu C J, Seyler T M. Are patients taking benzodiazepines at increased risk for complications following primary total knee arthroplasty? J Arthroplasty 2021; 36(5): 1611-16. doi: 10.1016\/j.arth.2020.12.004.","DOI":"10.1016\/j.arth.2020.12.004"},{"key":"129349","doi-asserted-by":"crossref","unstructured":"Beziz D, Colas S, Collin C, Dray-Spira R, Zureik M. Association between exposure to benzodiazepines and related drugs and survivorship of total hip replacement in arthritis: a population-based cohort study of 246,940 patients. 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Br J Anaesth 2023; 130(4): 459-67. doi: 10.1016\/j.bja.2022.12.024.","DOI":"10.1016\/j.bja.2022.12.024"},{"key":"129357","doi-asserted-by":"crossref","unstructured":"van Brug H E, Rosendaal F R, van Steenbergen L N, Nelissen R, Gademan M G J. Data linkage of two national databases: lessons learned from linking the Dutch Arthroplasty Register with the Dutch Foundation for Pharmaceutical Statistics. PLoS One 2023; 18(3): e0282519. doi: 10.1371\/journal.pone.0282519.","DOI":"10.1371\/journal.pone.0282519"},{"key":"129358","unstructured":"Centraal Bureau voor de Statistiek (CBS). New socioeconomic status scores for districts and neighbourhoods; 2024. 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Trends in benzodiazepine receptor agonists use and associated factors in the Belgian general older population: analysis of the Belgian health interview survey data. Ther Adv Psychopharmacol. 2021; 11: 20451253211011874. doi: 10.1177\/20451253211011874.","DOI":"10.1177\/20451253211011874"},{"key":"129362","doi-asserted-by":"crossref","unstructured":"Ma T T, Wang Z, Qin X, Ju C, Lau W C Y, Man K K C, et al. Global trends in the consumption of benzodiazepines and Z-drugs in 67 countries and regions from 2008 to 2018: a sales data analysis. Sleep 2023; 46(10): zsad124. doi: 10.1093\/sleep\/zsad124.","DOI":"10.1093\/sleep\/zsad124"},{"key":"129363","unstructured":"Rotteveel A H, Lambooij M S G, de Wit A. Benzodiazepinen uit het basispakket. Ned Tijdschr Geneeskd 2021. SOURCE???"},{"key":"129364","doi-asserted-by":"crossref","unstructured":"Kalkman G A, Kramers C, van Dongen R T, van den Brink W, Schellekens A. 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Hum Psychopharmacol 2024: e2891. doi: 10.1002\/hup.2891.","DOI":"10.1002\/hup.2891"},{"key":"129374","doi-asserted-by":"crossref","unstructured":"Bahoravitch T, Roberts M, Zhao A, Stake S, Ernst B, Thakkar S C. Trends From 2010 to 2019 in opioid and nonopioid pain management after total knee arthroplasty. J Am Acad Orthop Surg Glob Res Rev 2024; 8(6): e23.00062. doi: 10.5435\/JAAOSGlobal-D-23-00062.","DOI":"10.5435\/JAAOSGlobal-D-23-00062"},{"key":"129375","doi-asserted-by":"crossref","unstructured":"Kristiansen E B, Pedersen A B. Variation in risk of opioid therapy and association with mortality following hip or knee arthroplasty: an analysis based on 14 different definitions. Acta Orthop 2025; 96: 664-70. doi: 10.2340\/17453674.2025.44572.","DOI":"10.2340\/17453674.2025.44572"},{"key":"129376","doi-asserted-by":"crossref","unstructured":"Brat G A, Agniel D, Beam A, Yorkgitis B, Bicket M, Homer M, et al. Postsurgical prescriptions for opioid naive patients and association with overdose and misuse: retrospective cohort study. BMJ 2018; 360: j5790. doi: 10.1136\/bmj.j5790.","DOI":"10.1136\/bmj.j5790"},{"key":"129377","doi-asserted-by":"crossref","unstructured":"Brummett C M, Evans-Shields J, England C, Kong A M, Lew C R, Henriques C, et al. Increased health care costs associated with new persistent opioid use after major surgery in opioid-naive patients. J Manag Care Spec Pharm 2021; 27(6): 760-71. doi: 10.18553\/jmcp.2021.20507.","DOI":"10.18553\/jmcp.2021.20507"},{"key":"129378","doi-asserted-by":"crossref","unstructured":"Hansen J L, Heilig M, Kalso E, Stubhaug A, Knutsson D, Sandin P, et al. Problematic opioid use among osteoarthritis patients with chronic post-operative pain after joint replacement: analyses from the BISCUITS study. 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