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Finding the Balance Between Reduced Opioid Prescribing and Patient-reported Pain Management Among General Surgery Patients.
- Source :
-
Annals of surgery [Ann Surg] 2023 Aug 01; Vol. 278 (2), pp. 208-215. Date of Electronic Publication: 2022 Aug 26. - Publication Year :
- 2023
-
Abstract
- Objective: To compare patient-reported outcomes before and after implementation of evidence-based, procedure-specific opioid prescribing guidelines.<br />Background: The opioid epidemic remains a significant public health issue. Many institutions have responded by reducing opioid prescribing after surgery. However, the impact of this on patient-reported outcomes remains poorly understood.<br />Methods: Opioid-naïve adults undergoing 12 elective general surgery procedures at a single institution prospectively completed telephone surveys at median 26 days from discharge. Patients were compared before (March 2017-January 2018) and after (May 2019-November 2019) implementation of evidence-based, procedure-specific opioid prescribing guidelines.<br />Results: A total of 603 preguideline and 138 postguideline patients met inclusion criteria and completed surveys. Overall, 60.5% of preguideline and 92.5% of postguideline prescriptions fell within recommendations ( P <0.001), while refill rates were similar (4.5% vs 5.8%, P =0.50). A statistically significant drop in median morphine milligram equivalent prescribed was observed for 9 of 12 procedures (75%). No opioids were prescribed for 16.7% of patients in both cohorts ( P =0.98). While 93.3% of preguideline and 87.7% of postguideline patients were very/somewhat satisfied with their pain control, the proportion of patients who were very/somewhat dissatisfied increased from 4.2% to 9.4% ( P =0.039).<br />Conclusions: Prescribing guidelines successfully reduced opioid prescribing without increased refill rates. Despite decreased prescribing overall, there was a continued reluctance to prescribe no opioids after surgery. Although most patients experienced good pain control, there remains a subset of patients whose pain is not optimally managed in the era of reduced opioid prescribing.<br />Competing Interests: The authors report no conflicts of interest.<br /> (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)
Details
- Language :
- English
- ISSN :
- 1528-1140
- Volume :
- 278
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Annals of surgery
- Publication Type :
- Academic Journal
- Accession number :
- 35993582
- Full Text :
- https://doi.org/10.1097/SLA.0000000000005680