Publications
OPEN examines data, clinical practices and strategies to support better pain management, opioid stewardship, policy, treatment and care.
Postoperative Opioid Prescribing and the Pain Scores on Hospital Consumer Assessment of Healthcare Providers and Systems Survey
Lee JS, Hu HM, Brummett CM, et al. Postoperative Opioid Prescribing and the Pain Scores on Hospital Consumer Assessment of Healthcare Providers and Systems Survey. JAMA. 2017;317(19):2013-2015. doi:10.1001/jama.2017.2827- The Center for Medicare & Medicaid Services’ Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) captures key elements of patient satisfaction, including pain management. The study found no correlation between HCAHPS pain measures and postoperative opioid prescribing in surgical patients in Michigan.
- Clinicians can feel empowered to reduce their initial opioid prescription without harming patient satisfaction or their hospitals’ reimbursement.
Reduction in Opioid Prescribing Through Evidence-Based Prescribing Guidelines
Howard R, Waljee J, Brummett C, Englesbe M, Lee J. Reduction in Opioid Prescribing Through Evidence-Based Prescribing Guidelines. JAMA Surg. 2018;153(3):285-287. doi:10.1001/jamasurg.2017.4436- Prior to the intervention, post-laparoscopic cholecystectomy (gall bladder removal surgery) opioid prescribing exceeded patient pain management needs by approximately 88%, based on patient- reported opioid use.
- Implementation of evidence-based prescribing guidelines reduced post-laparoscopic cholecystectomy opioid prescribing by 63% without increasing the need for medication refills.
- Patients who received smaller opioid prescriptions after the intervention reported using fewer opioids, indicating that anchoring and adjustment heuristics may impact patient opioid use.
New Persistent Opioid Use Among Patients with Cancer After Curative-Intent Surgery
Lee JS, Hu HM, Edelman AL, et al. New Persistent Opioid Use Among Patients With Cancer After Curative-Intent Surgery. J Clin Oncol. 2017;35(36):4042-4049. doi:10.1200/JCO.2017.74.1363- 4% of cancer patients not on opioids prior to a curative-intent surgery fill prescriptions at daily doses similar to chronic opioid users one year after surgery.
- New persistent opioid use in patients receiving adjuvant chemotherapy is consistently higher than in those with no chemotherapy across different procedures.
- Changing prescribing guidelines and patient counseling in the surveillance and survivorship phases of care may reduce new persistent opioid use among cancer patients after surgery.
Persistent Opioid Use Among Pediatric Patients After Surgery
Harbaugh CM, Lee JS, Hu HM, et al. Persistent Opioid Use Among Pediatric Patients After Surgery. Pediatrics. 2018;141(1):e20172439. doi:10.1542/peds.2017-2439- Rates of new persistent opioid use among pediatric patients are comparable to those for adults, with 4.8% of patients refilling opioid prescriptions between 3 and 6 months after surgery.
- Risk factors for new persistent opioid use include type of surgical procedure and patient traits such as older age, female sex, previous substance use disorder, chronic pain, and preoperative opioid fill.
- Understanding the risks contributing to new persistent opioid use among adolescents and young adults may help clinicians to minimize opioid exposure and reduce risk for later misuse.
New Persistent Opioid Use After Minor and Major Surgical Procedures in US Adults
Brummett CM, Waljee JF, Goesling J, et al. New Persistent Opioid Use After Minor and Major Surgical Procedures in US Adults. JAMA Surg. 2017;152(6):e170504. doi:10.1001/jamasurg.2017.0504- New persistent opioid use after surgery is common, with approximately 6% of patients who were not on opioids before surgery continuing to use opioids more than 3 months after surgery.
- Patients continue to use their opioids for reasons other than the pain from surgery.
- New persistent opioid use after surgery is an underappreciated surgical complication that warrants increased attention.