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Patient Satisfaction and Pain Control Using an Opioid-Sparing Postoperative Pathway.

Publication ,  Journal Article
Hallway, A; Vu, J; Lee, J; Palazzolo, W; Waljee, J; Brummett, C; Englesbe, M; Howard, R
Published in: J Am Coll Surg
September 2019

BACKGROUND: Opioids are overprescribed after surgical procedures, leading to dependence and diversion into the community. This can be mitigated by evidence-based prescribing practices. We investigated the feasibility of an opioid-sparing pain management strategy after surgical procedures. STUDY DESIGN: Patients undergoing 6 procedures were offered the opportunity to participate in an opioid-sparing pain management pathway. Patients were advised to use acetaminophen and ibuprofen, and were provided with a small "rescue" opioid prescription for breakthrough pain. They were then surveyed postoperatively about opioid use and patient-reported outcomes measures. Overall cohort characteristics and differences between opioid users and non-users were analyzed. RESULTS: A total of 190 patients were analyzed. Median prescription size was 5 (interquartile range [IQR] 4 to 6) pills and opioid use was 0 (IQR 0 to 4) pills. Fifty-two percent of patients used no opioids after procedures. Median number of leftover pills was 2 (IQR 0 to 5). Median pain score was 1 (IQR 1 to 2) and satisfaction score was 10 (IQR 8 to 10). Almost all (91%) patients agreed that their pain was manageable. Patients who used opioids were younger (52 ± 14 vs 59 ± 13 years; p = 0.001), reported higher pain scores (2 [IQR 1 to 2] vs 1 [1 to 2]; p = 0.014), received larger rescue prescriptions (6 ± 3 vs 4 ± 4 pills; p = 0.003), and were less likely to agree that their pain was manageable (82% vs 98%; p = 0.001). There were no other significant differences between opioid users and non-users. CONCLUSIONS: Patients reported minimal or no opioid use after implementation of an opioid-sparing pathway, and still reported high satisfaction and pain control. These results demonstrate the effectiveness and acceptability of major reduction and even elimination of opioids after discharge from minor surgical procedures.

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Published In

J Am Coll Surg

DOI

EISSN

1879-1190

Publication Date

September 2019

Volume

229

Issue

3

Start / End Page

316 / 322

Location

United States

Related Subject Headings

  • Surgery
  • Practice Patterns, Physicians'
  • Patient Satisfaction
  • Pain, Postoperative
  • Pain Management
  • Middle Aged
  • Male
  • Ibuprofen
  • Humans
  • Female
 

Citation

APA
Chicago
ICMJE
MLA
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Hallway, A., Vu, J., Lee, J., Palazzolo, W., Waljee, J., Brummett, C., … Howard, R. (2019). Patient Satisfaction and Pain Control Using an Opioid-Sparing Postoperative Pathway. J Am Coll Surg, 229(3), 316–322. https://doi.org/10.1016/j.jamcollsurg.2019.04.020
Hallway, Alexander, Joceline Vu, Jay Lee, William Palazzolo, Jennifer Waljee, Chad Brummett, Michael Englesbe, and Ryan Howard. “Patient Satisfaction and Pain Control Using an Opioid-Sparing Postoperative Pathway.J Am Coll Surg 229, no. 3 (September 2019): 316–22. https://doi.org/10.1016/j.jamcollsurg.2019.04.020.
Hallway A, Vu J, Lee J, Palazzolo W, Waljee J, Brummett C, et al. Patient Satisfaction and Pain Control Using an Opioid-Sparing Postoperative Pathway. J Am Coll Surg. 2019 Sep;229(3):316–22.
Hallway, Alexander, et al. “Patient Satisfaction and Pain Control Using an Opioid-Sparing Postoperative Pathway.J Am Coll Surg, vol. 229, no. 3, Sept. 2019, pp. 316–22. Pubmed, doi:10.1016/j.jamcollsurg.2019.04.020.
Hallway A, Vu J, Lee J, Palazzolo W, Waljee J, Brummett C, Englesbe M, Howard R. Patient Satisfaction and Pain Control Using an Opioid-Sparing Postoperative Pathway. J Am Coll Surg. 2019 Sep;229(3):316–322.
Journal cover image

Published In

J Am Coll Surg

DOI

EISSN

1879-1190

Publication Date

September 2019

Volume

229

Issue

3

Start / End Page

316 / 322

Location

United States

Related Subject Headings

  • Surgery
  • Practice Patterns, Physicians'
  • Patient Satisfaction
  • Pain, Postoperative
  • Pain Management
  • Middle Aged
  • Male
  • Ibuprofen
  • Humans
  • Female