TUESDAY, Oct. 13, 2020 — Evidence-based guidelines successfully reduce postoperative opioid prescribing without increased refill rates, but pain control may not be optimal for some patients, according to a study presented Oct. 3 at the American College of Surgeons Clinical Congress 2020.
Cornelius A. Thiels, D.O., from Memorial Sloan Kettering Cancer Center in New York City, and colleagues surveyed opioid-naive adults undergoing 12 elective general surgery procedures at a single institution at a median 26 days postdischarge. Results were compared before (March 2017 to January 2018; 603 patients) and after (May 2019 to November 2019; 138 patients) implementation of a departmental evidence-based, procedure-specific opioid-prescribing guideline.
The researchers found that most postguideline discharge prescriptions (93.3 percent) fell within guidelines. The postguideline group consumed opioids for a median 4.0 days after surgery versus 3.0 days in the preguideline group (P = 0.007). Additionally, the postguideline group had worse patient-reported pain control (P = 0.002) and more patients reported being very or somewhat dissatisfied with their pain control (9.4 percent postguideline versus 4.2 percent in the preguideline group; P = 0.04). Following discharge, the proportion of patients responding they were not prescribed enough pain medications increased postimplementation (12.5 percent versus 4.9 percent; P = 0.002).
“The other finding of our research is that there’s still additional room to improve in terms of making sure all patients after surgery have their pain well controlled, because we believe there is a small subset of patients who have lower pain [control] scores with the reduced opioid prescribing guidelines,” Thiels said in a statement.
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