A preoperative interdisciplinary biopsychosocial opioid reduction program in patients on chronic opioid analgesia prior to spine surgery: A preliminary report and case series

Hassamal, Sameer; Haglund, Margaret; Wittnebel, Karl; Danovitch, Itai

doi:10.1016/j.sjpain.2016.06.007

Cited by 37 publications

(22 citation statements)

References 23 publications

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“…28 A PROMIS profile instrument (PROMIS 29a non-computer adaptive profile) was used in an interdisciplinary opioid reduction program in patients preparing to undergo spine surgery where significant benefits in pain interference occurred throughout the perioperative period. 29 Additionally, when compared to measures such as WHODAS and EQ5D, PROMIS has displayed similar performance in numerous populations. 30…”

Section: Quality Of Recovery Score (Qor) -Qor-9 Qor-15 Qor-40mentioning

confidence: 99%

American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Patient-Reported Outcomes in an Enhanced Recovery Pathway

Abola

Bennett‐Guerrero

Kent

et al. 2018

Anesthesia &Amp; Analgesia

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Patient-reported outcomes (PROs) are measures of health status that come directly from the patient. PROs are an underutilized tool in the perioperative setting. Enhanced recovery pathways (ERPs) have primarily focused on traditional measures of health care quality such as complications and hospital length of stay. These measures do not capture postdischarge outcomes that are meaningful to patients such as function or freedom from disability. PROs can be used to facilitate shared decisions between patients and providers before surgery and establish benchmark recovery goals after surgery. PROs can also be utilized in quality improvement initiatives and clinical research studies. An expert panel, the Perioperative Quality Initiative (POQI) workgroup, conducted an extensive literature review to determine best practices for the incorporation of PROs in an ERP. This international group of experienced clinicians from North America and Europe met at Stony Brook, NY, on December 2-3, 2016, to review the evidence supporting the use of PROs in the context of surgical recovery. A modified Delphi method was used to capture the collective expertise of a diverse group to answer clinical questions. During 3 plenary sessions, the POQI PRO subgroup presented clinical questions based on a literature review, presented evidenced-based answers to those questions, and developed recommendations which represented a consensus opinion regarding the use of PROs in the context of an ERP. The POQI workgroup identified key criteria to evaluate patient-reported outcome measures (PROMs) for their incorporation in an ERP. The POQI workgroup agreed on the following recommendations: (1) PROMs in the perioperative setting should be collected in the framework of physical, mental, and social domains. (2) These data should be collected preoperatively at baseline, during the immediate postoperative time period, and after hospital discharge. (3) In the immediate postoperative setting, we recommend using the Quality of Recovery-15 score. After discharge at 30 and 90 days, we recommend the use of the World Health Organization Disability Assessment Scale 2.0, or a tailored use of the Patient-Reported Outcomes Measurement Information System. (4) Future study that consistently applies PROMs in an ERP will define the role these measures will have evaluating quality and guiding clinical care. Consensus guidelines regarding the incorporation of PRO measures in an ERP were created by the POQI workgroup. The inclusion of PROMs with traditional measures of health care quality after surgery provides an opportunity to improve clinical care.

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Section: Quality Of Recovery Score (Qor) -Qor-9 Qor-15 Qor-40mentioning

confidence: 99%

American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Patient-Reported Outcomes in an Enhanced Recovery Pathway

Abola

Bennett‐Guerrero

Kent

et al. 2018

Anesthesia &Amp; Analgesia

View full text Add to dashboard Cite

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“…However whether these associations are reversible through preoperative opioid weaning or cessation remains unclear, our data lend support for an interdisciplinary biopsychosocial preoperative program to reduce opioid use that has been piloted by others. 35 Reduction of opioid use is not a simple task and requires input from counselors and psychologists with training to address the negative affect and increased comorbidities in this challenging cohort. Studies in this area have been largely confined to retrospective data and opinion, but some emerging data suggest that preoperative weaning from opioid use can improve outcomes.…”

Section: Management Of Preoperative Opioidsmentioning

confidence: 99%

Prevalence of Preoperative Opioid Use and Characteristics Associated With Opioid Use Among Patients Presenting for Surgery

et al. 2018

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“…This points to an opportunity to reduce opioid prescribing in the preoperative setting. Such preoperative opioid tapering has been shown to improve patient-reported outcomes following total joint arthroplasty 31,32 and to improve depression and anxiety, both of which are associated with worse pain postoperatively. 9,30,33 Increasing scores on the PHQ-9 (evaluating depression) and preoperative axial neck or back pain were other modifiable risk factors identified in this study.…”

Section: Discussionmentioning

confidence: 99%

Development and validation of a clinical prediction score for poor postoperative pain control following elective spine surgery

Yang

Riva-Cambrin

Cunningham³

et al. 2021

Journal of Neurosurgery: Spine

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OBJECTIVEThirty percent to sixty-four percent of patients experience poorly controlled pain following spine surgery, leading to patient dissatisfaction and poor outcomes. Identification of at-risk patients before surgery could facilitate patient education and personalized clinical care pathways to improve postoperative pain management. Accordingly, the aim of this study was to develop and internally validate a prediction score for poorly controlled postoperative pain in patients undergoing elective spine surgery.METHODSA retrospective cohort study was performed in adult patients (≥ 18 years old) consecutively enrolled in the Canadian Spine Outcomes and Research Network registry. All patients underwent elective cervical or thoracolumbar spine surgery and were admitted to the hospital. Poorly controlled postoperative pain was defined as a mean numeric rating scale score for pain at rest of > 4 during the first 24 hours after surgery. Univariable analysis followed by multivariable logistic regression on 25 candidate variables, selected through a systematic review and expert consensus, was used to develop a prediction model using a random 70% sample of the data. The model was transformed into an eight-tier risk-based score that was further simplified into the three-tier Calgary Postoperative Pain After Spine Surgery (CAPPS) score to maximize clinical utility. The CAPPS score was validated using the remaining 30% of the data.RESULTSOverall, 57% of 1300 spine surgery patients experienced poorly controlled pain during the first 24 hours after surgery. Seven significant variables associated with poor pain control were incorporated into a prediction model: younger age, female sex, preoperative daily use of opioid medication, higher preoperative neck or back pain intensity, higher Patient Health Questionnaire–9 depression score, surgery involving ≥ 3 motion segments, and fusion surgery. Notably, minimally invasive surgery, body mass index, and revision surgery were not associated with poorly controlled pain. The model was discriminative (C-statistic 0.74, 95% CI 0.71–0.77) and calibrated (Hosmer-Lemeshow goodness-of-fit, p = 0.99) at predicting the outcome. Low-, high-, and extreme-risk groups stratified using the CAPPS score had 32%, 63%, and 85% predicted probability of experiencing poorly controlled pain, respectively, which was mirrored closely by the observed incidence of 37%, 62%, and 81% in the validation cohort.CONCLUSIONSInadequate pain control is common after spine surgery. The internally validated CAPPS score based on 7 easily acquired variables accurately predicted the probability of experiencing poorly controlled pain after spine surgery.

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A preoperative interdisciplinary biopsychosocial opioid reduction program in patients on chronic opioid analgesia prior to spine surgery: A preliminary report and case series

Cited by 37 publications

References 23 publications

American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Patient-Reported Outcomes in an Enhanced Recovery Pathway

American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Patient-Reported Outcomes in an Enhanced Recovery Pathway

Prevalence of Preoperative Opioid Use and Characteristics Associated With Opioid Use Among Patients Presenting for Surgery

Development and validation of a clinical prediction score for poor postoperative pain control following elective spine surgery

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