Abstract
Introduction
Managing postoperative pain requires an individualized approach in order to balance adequate pain control with risk of persistent opioid use and narcotic abuse associated with inappropriately outsized narcotic prescriptions. Shared decision-making has been proposed to address individual pain management needs. We report here the results of a quality improvement initiative instituting prescribing guidelines using shared decision-making and preoperative pain expectation and management education to decrease excess opioid pills after surgery and improve patient satisfaction.
Methods
Pre-intervention prescribing habits were obtained by retrospective review perioperative pharmacy records for patients undergoing general surgeries in the 24 months prior to initiation of intervention. Patients scheduled to undergo General Surgery procedures were given a survey at their preoperative visit. Preoperative education was performed by the surgical team as a part of the Informed Consent process using a standardized handout and patients were asked to choose the number of narcotic pills they wished to obtain within prescribing recommendations. Postoperative surveys were administered during or after their 2-week postoperative visit.
Results
131 patients completed pre-intervention and post-intervention surveys. The average prescription size decreased from 12.29 oxycodone pills per surgery prior to institution of pathway to 6.80 pills per surgery after institution of pathway (p < 0.001). The percentage of unused pills after surgery decreased from an estimated 70.5% pre-intervention to 48.5% (p < 0.001) post-intervention. 61.1% of patients with excess pills returned or planned to return medication to the pharmacy with 16.8% of patients reporting alternative disposal of excess medication. Patient-reported satisfaction was higher with current surgery compared to prior surgeries (p < 0.001).
Conclusion
Institution of procedure-specific prescribing recommendations and preoperative pain management education using shared decision-making between patient and provider decreases opioid excess burden, resulting in fewer unused narcotic pills entering the community. Furthermore, allowing patients to participate in decision-making with their provider results in increased patient satisfaction.
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Acknowledgements
We would like to thank Dr. Amer Mujkanovic, Dr. Reginald Swift, and Stacy Arrazcaeta of Rubix Life Sciences for their statistical analysis. We would also like to thank the employees of the Dwight D Eisenhower Army Medical Center, including Hospital Command, Same Day Surgery/Preoperative Clinic, Post-Anesthesia Care Unit, and General Surgery clinic. We would especially like to thank the General Surgery attending surgeons and residents for their significant effort to institute this intervention.
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The authors Dr. Ciampa, Dr. Sherman, Dr. Liang, Dr. O’Hara, and Dr. Joel have no conflicts of interest or financial ties to disclose and no affiliations with or involvement in any organization with financial interest in the subject matter or materials discussed in this presentation.
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Ciampa, M.L., Liang, J., O’Hara, T.A. et al. Shared decision-making for postoperative opioid prescribing and preoperative pain management education decreases excess opioid burden. Surg Endosc 37, 2253–2259 (2023). https://doi.org/10.1007/s00464-022-09464-8
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DOI: https://doi.org/10.1007/s00464-022-09464-8