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Shetty PN, Sanghavi KK, Mete M, Giladi AM. Prescription Opioids and Patient-Reported Outcomes and Satisfaction After Carpal Tunnel Release Surgery. Hand (N Y) 2023; 18:772-779. [PMID: 34991385 PMCID: PMC10336819 DOI: 10.1177/15589447211064365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Amount of opioid use correlates poorly with procedure-related pain; however, prescription limits raise concerns about inadequate pain control and impacts on patient-reported quality indicators. There remain no consistent guidelines for postoperative pain management after carpal tunnel release (CTR). We sought to understand how postoperative opioid use impacts patient-reported outcomes after CTR. METHODS This is a pragmatic cohort study using prospectively collected data from all adult patients undergoing uncomplicated primary CTR over 17 months at our center. Patients were categorized as having received or not received a postoperative opioid prescription, and then as remaining on a prescription opioid at 2-week follow-up or not. Questionnaires were completed before surgery and at 2-week follow-up. We collected brief Michigan Hand questionnaire (bMHQ) score, Patient-Reported Outcomes Measurement Information System Global Health score, satisfaction, and pain score. RESULTS Of 505 included patients, 405 received a postoperative prescription and 67 continued use at 2-weeks. These 67 patients reported lower bMHQ, lower satisfaction, and higher postoperative pain compared to those that discontinued. Multivariable regressions showed that receiving postoperative prescriptions did not significantly influence outcomes or satisfaction. However, remaining on the prescription at 2 weeks was associated with significantly lower bMHQ scores, particularly in patients reporting less pain. CONCLUSIONS Patients remaining on a prescription after CTR reported worse outcomes compared to those who discontinued. Unexpectedly, the widest bMHQ score gap was seen across patients reporting lowest pain scores. Further research into this high-risk subgroup is needed to guide policy around using pain and patient-reported outcomes as quality measures.Level of Evidence: Level III.
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Affiliation(s)
- Pragna N. Shetty
- The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Kavya K. Sanghavi
- The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD, USA
- MedStar Health Research Institute, Hyattsville, MD, USA
| | - Mihriye Mete
- MedStar Health Research Institute, Hyattsville, MD, USA
| | - Aviram M. Giladi
- The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD, USA
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2
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Schneider BJ, Ehsanian R, Kennedy DJ, Schmidt A, Huynh L, Maher DP. The effect of patient satisfaction scores on physician clinical decision making: A possible factor driving utilization of opioid prescriptions, magnetic resonance imaging, and interventional spine procedures. INTERVENTIONAL PAIN MEDICINE 2022; 1:100012. [PMID: 39238821 PMCID: PMC11373071 DOI: 10.1016/j.inpm.2022.100012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/11/2022] [Accepted: 01/11/2022] [Indexed: 09/07/2024]
Abstract
Objective To survey the effect of patient satisfaction scores on pain physicians' medical decision making, with an emphasis on resource utilization. Design Email-based Survey. Methods Setting & Subjects: A 23-question survey was approved for dissemination to membership of a medical society and emailed to all members. The survey was also available online and via a promoted QR code. Results An email with link to the survey was viewed 1,116 times, and clicked on 223 times, with 75 members completing the survey online once the link was clicked. Thirty-three additional physicians directly accessed the survey online and completed it. Seventy-seven percent of physicians reported that patient satisfaction scores were tracked by their institution and were used as a consideration in financial compensation (22%) or performance review (36%). Over half of the physicians surveyed reported feeling that satisfaction scores would decline if they did not order MRI imaging, prescribe opioids or provide work restrictions/disability. Thirty percent reported to have performed a spine injection due to concern about patient satisfaction scores. Twenty-one reported that they had prescribed an opioid medication because of this concern. Lastly 25% and 24% have filled out disability paperwork or provided a disability parking placard respectively. Conclusions Over half of physicians surveyed reported having ordered physical therapy, MRIs, opioid medications, spine injections, or provided disability documentation over concern about how providing or not providing such things impacts patient satisfaction scores. This may be an unintended consequence of the current emphasis placed on patient satisfaction scores.
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Affiliation(s)
- Byron J Schneider
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Reza Ehsanian
- Division of Physical Medicine & Rehabilitation, Department of Department of Orthopedics & Rehabilitation, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - David J Kennedy
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Alex Schmidt
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lisa Huynh
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA, USA
| | - Dermot P Maher
- Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
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3
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Elsharydah A, Karani SY, Pothini T, Truong KH, Shu DJ, Ruikar KV, Huynh T, Tran CK. Prescription opioids are commonly unused after ambulatory head and neck surgeries: Opioids prescription presence and size has no effect on patient satisfaction with pain control. Am J Otolaryngol 2021; 42:103093. [PMID: 34090019 DOI: 10.1016/j.amjoto.2021.103093] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 05/24/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE To explore the opioid prescribing practices after common ambulatory head and neck surgeries in a large academic institution; and to examine the association between opioid prescription and the patient's satisfaction with pain control. METHODS This retrospective cohort study conducted in a tertiary academic medical center. Phone interviews of patients who underwent ambulatory head and neck surgeries one month after their procedures were conducted. The interview included, among several questions, the amount of opioid prescribed and consumed, the use of non-opioid pain medications, and the patient's satisfaction with pain control. Logistic regression models were used to investigate the significant factors affecting the patient's satisfaction with pain control. RESULTS Most patients were prescribed opioids at discharge (84%). Of those, 17% did not use their prescriptions. The median of leftover opioid was 76.50 morphine milligram equivalents (MMEs) with IQR (45-130.95). Patient satisfaction with pain control is not associated with opioid prescription at discharge (OR 0.195 [95% CL, 0.036-1.036], p = 0.059) or the amount of the prescribed opioid (OR 1.001 [95% CL, 0.997-1.004], p = 0.717) after controlling for other patient and procedural factors. CONCLUSION A significant portion of ambulatory head and neck surgery patients were discharged with opioid prescriptions they may not use. Patient satisfaction with pain control is not associated with the presence or the amount of opioid prescribed.
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Affiliation(s)
- Ahmad Elsharydah
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Sadia Y Karani
- University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Tanushri Pothini
- University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Kevin H Truong
- University of Texas Southwestern Medical School, Dallas, TX, USA
| | - David J Shu
- University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Kinnari V Ruikar
- University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Tinh Huynh
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Coby K Tran
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Kunkel ST, Gregory JJ, Sabatino MJ, Borsinger TM, Fillingham YA, Jevsevar DS, Moschetti WE. Does Preoperative Opioid Consumption Increase the Risk of Chronic Postoperative Opioid Use After Total Joint Arthroplasty? Arthroplast Today 2021; 10:46-50. [PMID: 34307810 PMCID: PMC8283033 DOI: 10.1016/j.artd.2021.05.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 04/09/2021] [Accepted: 05/16/2021] [Indexed: 11/24/2022] Open
Abstract
Background Risk-factor identification related to chronic opioid use after surgery may facilitate interventions mitigating postoperative opioid consumption. We evaluated the relationship between opioid use preceding total hip arthroplasty (THA) and total knee arthroplasty (TKA), and chronic use postoperatively, and the risk of chronic opioid use after total joint arthroplasty. Methods All primary THAs and TKAs performed during a 6-month period were identified. Opioid prescription and utilization data (in oxycodone equivalents) were determined via survey and electronic records. Relationship between preoperative opioid use and continued use >90 days after surgery was assessed via Chi-square, with significance set at P < .05. Results A total of 415 patients met inclusion criteria (240 THAs and 175 TKAs). Of the 240 THAs, 199 (82.9%) patients and of the 175 TKAs, 144 (82.3%) patients agreed to participate. Forty-three of 199 (21.6%) THA patients and 22 of 144 (15.3%) TKA patients used opioids within 30 days preoperatively. Nine of 199 (4.5%) THA and 10 of 144 (6.9%) TKA patients had continued use of opioids for >90 days postoperatively. Preoperative opioid consumption was significantly associated with chronic use postoperatively for THA (P = .011) and TKA (P = .024). Five of 43 (11.6%) THA and 4 of 22 (18.2%) TKA patients with preoperative opioid use had continued use for >90 days postoperatively. For opioid naïve patients, 2.6% (4/156) of THA and 4.9% (6/122) of TKA patients had chronic use postoperatively. Conclusions Preoperative opioid use was associated with nearly 5-fold and 4-fold increase in percentage of patients with chronic opioid use after THA and TKA, respectively. Surgeons should counsel patients regarding this risk and consider strategies to eliminate preoperative opioid use.
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Affiliation(s)
- Samuel T Kunkel
- Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - James J Gregory
- Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Matthew J Sabatino
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, USA
| | - Tracy M Borsinger
- Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Yale A Fillingham
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - David S Jevsevar
- Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Wayne E Moschetti
- Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
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Bloom DA, Manjunath AK, Gotlin MJ, Hurley ET, Jazrawi LM, Virk MS, Kwon YM, Zuckerman JD. Institutional reductions in opioid prescribing do not change patient satisfaction on Press Ganey surveys after total shoulder arthroplasty. J Shoulder Elbow Surg 2021; 30:858-864. [PMID: 32712454 DOI: 10.1016/j.jse.2020.07.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/06/2020] [Accepted: 07/07/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND With an ongoing opioid epidemic in the United States, it is important to examine if decreased opioid prescribing can affect patient experience, namely satisfaction with pain control. PURPOSE The purpose of this study was to investigate what effect, if any, decreased opioid prescribing after total shoulder arthroplasty had on Press Ganey satisfaction surveys. METHODS A retrospective review was conducted on patients who underwent primary anatomic or reverse total shoulder arthroplasty between October 2014 and October 2019. Patients with complete Press Ganey survey information and no history of trauma, fracture, connective tissue disease, or prior shoulder arthroplasty surgery were included in the analysis. Patients were segregated into 2 groups, pre-protocol and post-protocol, based on the date of surgery relative to implementation of an institutional opioid reduction protocol, which occurred in October 2018. Prescriptions were converted to morphine milligram equivalents (MME) for direct comparison between different opioid medications. RESULTS A total of 201 patients met inclusion criteria, and there were 110 reverse total shoulder arthroplasties and 91 anatomic total shoulder arthroplasties. Average opioids prescribed on discharge for the pre-protocol group were 426.3 ± 295 MME (equivalent to 56.8 tablets of oxycodone 5 mg), whereas after the initiation of the protocol, they were 193.8 ± 199 MME (equivalent to 25.8 tablets of oxycodone 5 mg); P < .0001. Average satisfaction with pain control did not change significantly between pre-protocol and post-protocol (4.71 ± 0.65 pre-protocol and 4.74 ± 0.44 post-protocol, P = .82). CONCLUSION A reduction in opioids prescribed after a total shoulder replacement is not associated with any negative effects on patient satisfaction, as measured by the Press Ganey survey.
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Affiliation(s)
- David A Bloom
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA.
| | - Amit K Manjunath
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Matthew J Gotlin
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Eoghan T Hurley
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Laith M Jazrawi
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Mandeep S Virk
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Young M Kwon
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Joseph D Zuckerman
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
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North F, Pecina JL, Tulledge-Scheitel SM, Chaudhry R, Matulis JC, Ebbert JO. Is a switch to a different electronic health record associated with a change in patient satisfaction? J Am Med Inform Assoc 2021; 27:867-876. [PMID: 32357370 PMCID: PMC7309264 DOI: 10.1093/jamia/ocaa026] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 02/09/2020] [Accepted: 02/28/2020] [Indexed: 11/14/2022] Open
Abstract
Objective Financial impacts associated with a switch to a different electronic health record (EHR) have been documented. Less attention has been focused on the patient response to an EHR switch. The Mayo Clinic was involved in an EHR switch that occurred at 6 different locations and with 4 different “go-live” dates. We sought to understand the relationship between patient satisfaction and the transition to a new EHR. Materials and Methods We used patient satisfaction data collected by Press Ganey from July 2016 through December 2019. Our patient satisfaction measure was the percent of patients responding “very good” (top box) to survey questions. Twenty-four survey questions were summarized by Press Ganey into 6 patient satisfaction domains. Piecewise linear regression was used to model patient satisfaction before and after the EHR switch dates. Results Significant drops in patient satisfaction were associated with the EHR switch. Patient satisfaction with access (ease of getting clinic on phone, ease of scheduling appointments, etc.) was most affected (range of 6 sites absolute decline: -3.4% to -8.8%; all significant at 99% confidence interval). Satisfaction with providers was least affected (range of 6 sites absolute decline: -0.5% to -2.8%; 4 of 6 sites significant at 99% confidence interval). After 9-15 months, patient satisfaction with access climbed back to pre-EHR switch levels. Conclusions Patient satisfaction in several patient experience domains dropped significantly and stayed lower than pre–“go-live” for several months after a switch in EHR. Satisfaction with providers declined less than satisfaction with access.
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Affiliation(s)
- Frederick North
- Division of Community Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jennifer L Pecina
- Department of Family Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Sidna M Tulledge-Scheitel
- Division of Community Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Rajeev Chaudhry
- Division of Community Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - John C Matulis
- Division of Community Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jon O Ebbert
- Division of Community Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
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7
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Titan A, Doyle A, Pfaff K, Baiu I, Lee A, Graham L, Shelton A, Hawn M. Impact of policy-based and institutional interventions on postoperative opioid prescribing practices. Am J Surg 2021; 222:766-772. [PMID: 33593614 DOI: 10.1016/j.amjsurg.2021.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/26/2021] [Accepted: 02/05/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND We assessed the impact of policy-based and institutional interventions to limit postoperative opioid prescribing. METHODS Retrospective cohort study of patients who underwent laparoscopic/open appendectomies, laparoscopic/open cholecystectomies, and laparoscopic/open inguinal hernia repair during a 6-month interval in 2018 (control), 2019 (post-policy intervention), and 2020 (post-institutional intervention) to assess changes in postoperative opioid prescribing patterns. A survey was collected for the 2020 cohort. RESULTS Comparing the 762 patients identified in 2018, 2019, and 2020 cohorts there was a significant decrease in mean opioid tabs prescribed (23.5 ± 8.9 vs. 16.2 ± 7.0 vs. 12.8 ± 4.9, p < 0.01) and mean OME dosage (148.0 ± 68.0 vs. 108.6 ± 51.8 vs. 95.4 ± 38.0, p < 0.01), without a difference in refill requests. Patient survey (response rate 63%) indicated 91.4% of patients reported sufficient pain control. CONCLUSION Formalized opioid-prescribing guidelines and statewide regulations can significantly decrease postoperative opioid prescribing with good patient satisfaction. Surgeon education may facilitate efforts to minimize narcotic over-prescription without compromising pain management.
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Affiliation(s)
- Ashley Titan
- Department of Surgery, Stanford University Hospital, Stanford, CA, USA
| | - Alexis Doyle
- Department of Surgery, Stanford University Hospital, Stanford, CA, USA
| | - Kayla Pfaff
- Department of Surgery, Stanford University Hospital, Stanford, CA, USA
| | - Ioana Baiu
- Department of Surgery, Stanford University Hospital, Stanford, CA, USA
| | - Angela Lee
- Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Laura Graham
- Department of Surgery, Stanford University Hospital, Stanford, CA, USA
| | - Andrew Shelton
- Department of Surgery, Stanford University Hospital, Stanford, CA, USA
| | - Mary Hawn
- Department of Surgery, Stanford University Hospital, Stanford, CA, USA.
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Schneider BJ, Ehsanian R, Schmidt A, Huynh L, Kennedy DJ, Maher DP, Haring S. The effect of patient satisfaction scores on physician job satisfaction and burnout. Future Sci OA 2020; 7:FSO657. [PMID: 33437508 PMCID: PMC7787140 DOI: 10.2144/fsoa-2020-0136] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Physician burnout is recognized as reversible with the potential to negatively influence quality of care and patient outcomes. The study objective was to evaluate associations between patient satisfaction scores (PSS) and physicians' perceptions of job satisfaction and burnout via a physician survey. Eighty two out of 107 report PSS are institutionally tracked, with 23/107 and 39/107 reporting PSS utilization in financial compensation or performance review, respectively. Fifty four out of 107, report pressure to emphasize PSS; 63/107, report PSS having negative effect on job satisfaction; 31/107 considered leaving their job or career due to PSS and 84/107 report PSS contribute to burnout. In the cohort of physicians treating patients with spine pain who responded to this survey, PSS are associated with decreased job satisfaction and increased burnout.
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Affiliation(s)
- Byron J Schneider
- Department of Physical Medicine & Rehabilitation, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN 37212, USA
| | - Reza Ehsanian
- Department of Neurosurgery, Division of Physical Medicine & Rehabilitation, University of New Mexico School of Medicine, Albuquerque, NM 87106, USA
| | - Alex Schmidt
- Department of Physical Medicine & Rehabilitation, Vanderbilt University Medical Center, Nashville, TN 37212, USA
| | - Lisa Huynh
- Department of Orthopaedic Surgery, Stanford University, Stanford, CA 94063, USA
| | - David J Kennedy
- Department of Physical Medicine & Rehabilitation, Center for Musculoskeletal Research, Vanderbilt University Medical Center, Nashville, TN 37212, USA
| | - Dermot P Maher
- Department of Anesthesiology & Critical Care Medicine, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Sterling Haring
- Department of Physical Medicine & Rehabilitation, Vanderbilt University Medical Center, Nashville, TN 37212, USA.,Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
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Ziegelmann MJ, Findlay BL, Britton CJ, Habermann EB. Opioid prescribing after urologic surgery: we are part of the problem and part of the solution-an invited commentary on "an opioid prescription for men undergoing minor urologic surgery is associated with an increased risk of new persistent opioid use". Transl Androl Urol 2020; 9:997-1000. [PMID: 32676382 PMCID: PMC7354322 DOI: 10.21037/tau-2020-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
| | | | | | - Elizabeth B Habermann
- The Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery Surgical Outcomes Program, Mayo Clinic, Rochester, MN, USA
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10
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Priest CR, Kenney BC, Brummett CM, Waljee JF, Englesbe MJ, Nalliah RP. Increased opioid prescription fills after dental procedures performed before weekends and holidays. J Am Dent Assoc 2020; 151:388-398.e1. [PMID: 32450977 DOI: 10.1016/j.adaj.2020.03.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 03/02/2020] [Accepted: 03/15/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Excess opioid prescriptions place patients and communities at risk of experiencing opioid-related morbidity. The authors designed a study to test the hypothesis that opioid prescription fills would be more common after dental procedures performed the day before a weekend or holiday than other weekdays. METHODS The authors performed a retrospective cohort study of 2,060,317 people, integrating Truven Health MarketScan insurance claims to evaluate variation in opioid fills for dental procedures performed the day before a weekend or holiday compared with other weekdays. Opioid-naïve people, aged 13 through 64 years, with eligible procedures from 2013 through 2017 were included. The primary outcome measure was a prescription opioid fill on the same date as the dental procedure. RESULTS Multivariable logistic regression results showed significantly higher odds of filling an opioid prescription for patients with procedures the day before weekends and holidays (adjusted odds ratio, 1.27; 95% confidence interval, 1.26 to 1.28) than for patients with procedures on other weekdays. In addition, the youngest age category, 13 through 29 years, had the highest odds of filling an opioid prescription compared with other age categories (reference category: patients aged 50-64 years, adjusted odds ratio, 1.43; 95% confidence interval, 1.41 to 1.44). CONCLUSIONS Outpatient dental procedures performed the day before a weekend or holiday were associated with a 27% increased adjusted odds of filling a prescription for an opioid. PRACTICAL IMPLICATIONS Although patients and dentists might be concerned about the challenges of unmanaged pain on weekends and holidays, opioids are not warranted for most dental procedures and should be replaced with patient education and nonopioid analgesics. Oral health care professionals concerned about postprocedural pain control should consider scheduling complex procedures earlier in the week, when emergency care is available to reduce unwarranted preemptive prescribing of opioids, which might be driving increased opioid fills before weekends and holidays.
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11
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Sceats LA, Ayakta N, Merrell SB, Kin C. Drivers, Beliefs, and Barriers Surrounding Surgical Opioid Prescribing: A Qualitative Study of Surgeons’ Opioid Prescribing Habits. J Surg Res 2020; 247:86-94. [DOI: 10.1016/j.jss.2019.10.039] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 09/30/2019] [Accepted: 10/19/2019] [Indexed: 02/02/2023]
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McAuliffe Staehler TM, Palombi LC. Beneficial opioid management strategies: A review of the evidence for the use of opioid treatment agreements. Subst Abus 2020; 41:208-215. [PMID: 31900073 DOI: 10.1080/08897077.2019.1692122] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background: The Centers for Disease Control and Prevention (CDC) and American Society of Interventional Pain Physicians (ASIPP) guidelines recommend opioid treatment agreements to reduce the misuse and abuse of opioids, but evidence of their effectiveness has not been well-established. This controversy has led to their varied use in primary care settings. The purpose of this review is to collect studies that assess the value of opioid treatment agreements and associated opioid misuse outcomes in patients with chronic non-cancer pain. Methods: This study used a modified preferred reporting items for systematic reviews and meta-analyses (PRISMA) approach which is organized by five distinct elements or steps: beginning with a clearly formulated question, using the question to develop clear inclusion criteria to identify relevant studies, using an approach to appraise the studies or a subset of the studies, summarizing the evidence using an explicit methodology, and interpreting the findings of the review. Results: Of 283 articles identified, six eligible studies were evaluated and assessed for quality. The study design, setting, and participants varied across the studies evaluated, and the methods of measuring primary and secondary outcomes were also diverse across all studies. One study was a randomized clinical trial (RCT), four studies were retrospective cohort studies (RCS), and one study was a prospective cohort study (PCS). The design, methods, and indication for misuse of these studies contributed to quality scores of very low for one study, low for four studies, and moderate for one study. Conclusion: This systematic review shows weak evidence to support the effectiveness of patient prescriber agreements in the reduction and mitigation of opioid misuse and abuse. Further research is needed to determine if these agreements are beneficial as an opioid management strategy.
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Affiliation(s)
- Tuesday M McAuliffe Staehler
- Department of Pharmacy Practice and Pharmaceutical Science, University of Minnesota, College of Pharmacy, Duluth, Minnesota, USA
| | - Laura C Palombi
- Department of Pharmacy Practice and Pharmaceutical Science, University of Minnesota, College of Pharmacy, Duluth, Minnesota, USA
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13
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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; 229:316-322. [PMID: 31154092 DOI: 10.1016/j.jamcollsurg.2019.04.020] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 04/15/2019] [Accepted: 04/15/2019] [Indexed: 12/20/2022]
Abstract
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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Affiliation(s)
- Alexander Hallway
- Michigan Opioid Prescribing and Engagement Network, Ann Arbor, MI; Department of Surgery, University of Michigan Health System, Ann Arbor, MI
| | - Joceline Vu
- Michigan Opioid Prescribing and Engagement Network, Ann Arbor, MI; Department of Surgery, University of Michigan Health System, Ann Arbor, MI
| | - Jay Lee
- Michigan Opioid Prescribing and Engagement Network, Ann Arbor, MI; Department of Surgery, University of Michigan Health System, Ann Arbor, MI
| | - William Palazzolo
- Department of Surgery, University of Michigan Health System, Ann Arbor, MI
| | - Jennifer Waljee
- Michigan Opioid Prescribing and Engagement Network, Ann Arbor, MI; Section of Plastic Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI
| | - Chad Brummett
- Michigan Opioid Prescribing and Engagement Network, Ann Arbor, MI; Department of Anesthesia, University of Michigan Health System, Ann Arbor, MI
| | - Michael Englesbe
- Michigan Opioid Prescribing and Engagement Network, Ann Arbor, MI; Section of Transplant Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, MI.
| | - Ryan Howard
- Michigan Opioid Prescribing and Engagement Network, Ann Arbor, MI; Department of Surgery, University of Michigan Health System, Ann Arbor, MI
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