OPEN examines data, clinical practices and strategies to support better pain management, opioid stewardship, policy, treatment and care.
The Association of Postoperative Opioid Prescriptions with Patient OutcomesHoward, R; Brown, CS; Lai, YL; Gunaseelan, V; Chua, KP; Brummett, C; Englesbe, M; Waljee, J; Bicket, MC. The Association of Postoperative Opioid Prescriptions with Patient Outcomes. Annals of Surgery. Published online 4 June 2021. DOI: 10.1097/SLA.0000000000004965
- Patients who were not prescribed opioids after surgery had similar clinical and patient-reported outcomes as patients who were prescribed opioids.
- This suggests that minimizing opioids as part of routine postoperative care is unlikely to adversely affect patients.
The Impact of Complications and Pain on Patient SatisfactionBerkowitz R, Vu J, Brummett C, Waljee J, Englesbe M, Howard R. The Impact of Complications and Pain on Patient Satisfaction. Annals of Surgery. Published online 1 June 2021. DOI: 10.1097/SLA.0000000000003621
- The predicted probability of being highly satisfied after surgery was 79% for patients who had no complications and 88% for patients who had no pain.
- Patients who experienced postoperative complications and pain were less likely to be highly satisfied or have no regret.
- Notably, postoperative pain has a more significant effect on satisfaction and regret after surgery, suggesting focused postsurgical pain management is an opportunity to substantially improve patient experiences.
A Qualitative Study of Patient Protection against Postoperative Opioid Addiction: A Thematic Analysis of Self-AgencyCho HE, Billig JI, Byrnes ME, Nasser JS, Kocheril AP, Haase SC, Waljee JF, Chung KC. A Qualitative Study of Patient Protection against Postoperative Opioid Addiction: A Thematic Analysis of Self-Agency. Plastic and Reconstructive Surgery. Published online 1 May 2021. DOI: 10.1097/PRS.0000000000007841
- Participants actively sought out protective mechanisms supporting their decision on opioid use, but sometimes did so unconsciously. Participants integrated a strong sense of self in their decision-making processes.
- A robust understanding of how patients choose to take opioids for postoperative pain control is imperative to develop patient-centered strategies to treat the opioid epidemic.
- Effective opioid-reduction policies should consider patients as active agents who negotiate various internal and external influences in their decision-making processes.
Predicting postoperative opioid use with machine learning and insurance claims in opioid-naïve patientsHur J; Tang S; Gunaseelan V; Vu J; Brummett CM; Englesbe MJ; Waljee JF; Wiens J. Predicting postoperative opioid use with machine learning and insurance claims in opioid-naïve patients. American Journal of Surgery. Published online 26 March 2021. DOI: https://doi.org/10.1016/j.amjsurg.2021.03.058
- Potential predictors included sociodemographic data, comorbidities, and prescriptions within one year prior to surgery.
- Undergoing major surgery, opioid prescriptions within 30 days prior to surgery, and abdominal pain were useful in predicting refills; back/joint/head pain were the most important features in predicting new persistent use.
- Preoperative patient attributes from insurance claims could potentially be useful in guiding prescription practices for opioid-naïve patients.
Association of Postoperative Opioid Prescription Size and Patient SatisfactionFry BT; Howard RA; Gunaseelan V; Lee JS; Waljee JF; Englesbe MJ; Vu JV. Association of Postoperative Opioid Prescription Size and Patient Satisfaction. Annals of Surgery. Published online 1 February 2021. DOI: 10.1097/SLA.0000000000004784
- In a large cohort of patients undergoing common surgical procedures, there was no association between opioid prescription size at discharge after surgery and patient satisfaction.
- This suggests surgeons may continue to decrease postoperative opioid prescription sizes in order to mitigate opioid-related risks without compromising patient satisfaction.
Association of Opioid Type with Opioid Consumption after SurgeryZikovich S; Gunaseelan V; Englesbe MJ; Waljee JF; Brummett CM. Association of Opioid Type with Opioid Consumption after Surgery. Annals of Surgery. Published online 10 February 2021. DOI: 10.1097/SLA.0000000000004793
- Patients prescribed hydrocodone consumed 7 tablets (95% CI 6.79-7.18) while patients prescribed oxycodone consumed 6 tablets (95% CI 5.58-6.40.)
- Although patients prescribed hydrocodone consumed more tablets than patients prescribed oxycodone, this difference was not clinically significant and did not result in differences in satisfaction, pain, or refills.
- Perioperative opioid prescribing guidelines may recommend the same number of 5 mg oxycodone and hydrocodone tablets without sacrificing patient-reported outcomes.
Patient-Reported Outcomes After Opioid-Sparing Surgery Compared With Standard of CareAnderson M; Hallway A; Brummett CM; Waljee JF; Englesbe MJ; Howard RA. Patient-Reported Outcomes After Opioid-Sparing Surgery Compared With Standard of Care. JAMA Surgery. Published online 27 January 2021. DOI: 10.1001/jamasurg.2020.5646
- Patients participating in an opioid-sparing postoperative pathway received and used fewer opioids but reported less pain and similar satisfaction compared with patients receiving standard of care.
- In the opioid-sparing pathway, 36.8% of patients did not receive an opioid prescription compared with 0% of patients receiving standard of care.
- Importantly, more patients in the opioid-sparing group received no opioid prescription, which avoids the risk of diversion into communities.
Relationship between initial opioid prescription size and likelihood of refill after spine surgeryMassie L, Gunaseelan V, Waljee J, Brummett C, Schwalb JM. Relationship between initial opioid prescription size and likelihood of refill after spine surgery. The Spine Journal. Published online 16 January 2021.DOI: https://doi.org/10.1016/j.spinee.2021.01.016
- About 26.3% of opioid-naïve patients obtained refills of their opioid prescriptions within 30 days of surgery.
- The likelihood of obtaining a refill was unchanged with the size of the initial perioperative prescription across procedure categories.
- Patient factors associated with increased likelihood of refills included age 30 to 39 years, female gender, anxiety disorder, mood disorder, and history of alcohol/substance abuse.
- For opioid-naïve patients, surgeons can prescribe lower amounts of opioids after elective surgery for degenerative spinal disease without concern of increased need for refills.
Prevalence and Patterns of Opioid Use Before and After Liver TransplantationCron DC, Tincopa MA, Lee JS, Waljee AK, Hammoud A, Brummett CM, Waljee JF, Englesbe MJ, MD, and Sonnenday CJ. Prevalence and Patterns of Opioid Use Before and After Liver Transplantation. Transplantation. Published online 1 January 2021. DOI: 10.1097/TP.0000000000003155
- Prescription opioid use is common before and after liver transplant, with intermittent and chronic use largely persisting, and a small development of new chronic use posttransplant.
- Among previously opioid-naïve patients, 4% developed chronic use posttransplant.
- Among patients with pretransplant opioid use, 84% remained intermittent or increased to chronic use, and 73% of chronic users remained chronic users after transplant.
- To minimize the morbidity of long-term opioid use, it is critical to improve pain management and optimize opioid use before and after liver transplant.
Higher Amounts of Opioids Filled After Surgery Increase Risk of Serious Falls and Fall-Related Injuries Among Older AdultsSantosa KB, Lai YL, Brummett CM, et al. Higher Amounts of Opioids Filled After Surgery Increase Risk of Serious Falls and Fall-Related Injuries Among Older Adults [published online ahead of print, 2020 Aug 3]. J Gen Intern Med. 2020. doi:10.1007/s11606-020-06015-6
- Among opioid naïve Medicare patients aged 65 and older who underwent elective outpatient surgery, 76.3% filled a perioperative opioid prescription, and 0.62% suffered a serious fall or fall-related injury within 30 days after surgery.
- Higher amount of opioid filled over 30 days prior to surgery through to 30 days after surgery was strongly associated with increased risk of serious falls after surgery; patients who filled ≥ 225 OMEs after surgery were over twice as likely to fall after surgery compared with the group who filled < 150 OME (RR 2.29, 95% CI 1.72–3.07).
- Older age, being female, and dual Medicaid eligibility were also associated with higher risk of serious falls and fall-related injuries.