Tapentadol versus Oxycodone for Opioid-related Adverse Drug Events and Clinical Outcomes After Inpatient Surgery

Oxycodone is a commonly prescribed opioid for postoperative pain. However, there has been a marked increase in the use of tapentadol over the previous decade due to a perceived superior safety profile of tapentadol compared to oxycodone. There is limited real-world evidence on the safety of tapentadol compared to oxycodone after surgery. The primary objective was to examine the impact of tapentadol compared to oxycodone use on the incidence of opioid-related adverse drug events after surgery. Data for adult surgical patients receiving tapentadol or oxycodone during hospitalisation between 1 January 2018 and 31 December 2021 were collected from electronic medical records of three tertiary metropolitan hospitals in Australia. The primary outcome was the incidence of opioid-related adverse events. Patients receiving tapentadol or oxycodone were matched using nearest-neighbour propensity score matching. In the matched cohorts (n = 1,530 vs. n = 2,775; mean [standard deviation, SD] age 62.3 [17.0] years vs. 61.9 [SD 17.9] years; 43% vs. 45% male for the tapentadol vs. oxycodone groups, respectively), patients given tapentadol experienced a similar incidence of adverse events overall (14.4%, 220/1530 vs. 12.6%, 349/2775; p = 0.100; 95% CI -0.35% to 3.95%),. Secondary outcomes included an increased risk of delirium (2.7%, 41/1,530 vs. 1.3%, 37/2,775), arrhythmias (3.4%, 52/1,530 vs. 2.2%, 62/2,775), and length of hospital stay (5 [range1-201] vs. 4 [range 1-226] days) compared with oxycodone use. Further real-world studies are warranted to determine the impact of tapentadol use on a broad range of patient outcomes. This study provides an early signal that tapentadol use may be associated with an increased risk of some adverse events and a longer length of stay. Further research is needed to examine the impact of tapentadol use on a broad range of patient outcomes in clinical practice settings. •Patients given tapentadol or oxycodone after surgery were matched using propensity score matching•Tapentadol was linked with similar side effects overall compared with oxycodone use after surgery•Tapentadol was linked with more delirium, arrythmias and longer hospital stay than oxycodone