Effects of preoperative opioid education on postoperative opioid use and pain management in orthopaedics: A systematic review

Rucinski, Kylee; Cook, James L.

doi:10.1016/j.jor.2020.01.020

Cited by 39 publications

(33 citation statements)

References 24 publications

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“…This is a central component of our approach based on collective evidence showing that managing patient expectations before surgery reduces patient anxiety, perioperative opioid consumption, and hospital length of stay. [28][29][30] The other main function of a TPS is to ensure that this personalized pain management plan is carried out across all transitions of care. A TPS coordinates care across all transitions in the inpatient and outpatient setting and effectively lowers the risk that patient information is miscommunicated among surgical and non-surgical providers.…”

Section: Discussionmentioning

confidence: 99%

Opioid use among veterans undergoing major joint surgery managed by a multidisciplinary transitional pain service

Buys

Bayless

Romesser

et al. 2020

Reg Anesth Pain Med

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BackgroundChronic postsurgical pain and opioid use is a problem among patients undergoing many types of surgical procedures. A multidisciplinary approach to perioperative pain management known as a transitional pain service (TPS) may lower these risks.MethodsThis retrospective cohort study was conducted at the Salt Lake City VA Medical Center to compare patients undergoing elective primary or revision total knee, hip, or shoulder replacement or rotator cuff repair in the year before (2017) and after (2018) implementation of a TPS. The primary outcome is the proportion of patients taking opioids 90 days after surgery. Secondary outcomes include new chronic opioid use (COU) after surgery as well as the proportion of previous chronic opioid users who stopped or decreased opioid use after surgery.ResultsAt 90 days after surgery, patients enrolled in TPS were significantly less likely to be taking opioids (13.4% TPS vs 27.3% pre-TPS; p=0.002). This relationship remained statistically significant in a multivariable logistic regression analysis, where the TPS group had 69% lower odds of postoperative COU compared with the preintervention group (OR: 0.31; 95% CI: 0.14 to 0.66; p=0.03). Opioid-naive patients enrolled in TPS were less likely to have new COU after surgery (0.7% TPS vs 8.4% pre-TPS; p=0.004). Further, patients enrolled in TPS with existing COU prior to surgery were more likely to reduce or completely stop opioid use after surgery (67.5% TPS vs 45.3% pre-TPS; p=0.037) as compared with pre-TPS.ConclusionsThese data suggest that a TPS is an effective strategy for preventing new COU and reducing overall opioid use following orthopedic joint procedures in a Veterans Affairs hospital.

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Section: Discussionmentioning

confidence: 99%

Opioid use among veterans undergoing major joint surgery managed by a multidisciplinary transitional pain service

Buys

Bayless

Romesser

et al. 2020

Reg Anesth Pain Med

View full text Add to dashboard Cite

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“…To this end, various predictive tools for postoperative pain are being explored [88][89][90][91]. Patient-centered education and expectation management during the pre-admission phase of care are effective strategies for improving postoperative pain control, limiting postoperative opioid use, decreasing complications and readmissions, and increasing postoperative function and quality of life [15,18,[92][93][94][95][96][97][98]. Insufficient evidence exists to support specific educational strategies or components, but current guidelines recommend an individualized discussion about expected severity and duration of postoperative pain to generate realistic goals about pain management, a description of how pain will be assessed, and an overview of available analgesic options, including the judicious use of opioids and their associated risks, multimodal therapies in the form of nonopioid medications, local anesthetic or regional (central and peripheral) techniques, and nonpharmacologic modalities [15].…”

Section: Patient Pain History Evaluation and Educationmentioning

confidence: 99%

Perioperative Pain Management and Opioid Stewardship: A Practical Guide

et al. 2021

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Surgical procedures are key drivers of pain development and opioid utilization globally. Various organizations have generated guidance on postoperative pain management, enhanced recovery strategies, multimodal analgesic and anesthetic techniques, and postoperative opioid prescribing. Still, comprehensive integration of these recommendations into standard practice at the institutional level remains elusive, and persistent postoperative pain and opioid use pose significant societal burdens. The multitude of guidance publications, many different healthcare providers involved in executing them, evolution of surgical technique, and complexities of perioperative care transitions all represent challenges to process improvement. This review seeks to summarize and integrate key recommendations into a “roadmap” for institutional adoption of perioperative analgesic and opioid optimization strategies. We present a brief review of applicable statistics and definitions as impetus for prioritizing both analgesia and opioid exposure in surgical quality improvement. We then review recommended modalities at each phase of perioperative care. We showcase the value of interprofessional collaboration in implementing and sustaining perioperative performance measures related to pain management and analgesic exposure, including those from the patient perspective. Surgery centers across the globe should adopt an integrated, collaborative approach to the twin goals of optimal pain management and opioid stewardship across the care continuum.

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“…13,31 As a result, several studies have supported preoperative opioid education in curbing excess opioid utilization. 1,16,46 However, the general prevalence of opioid use before hip arthroscopy is extremely high relative to its arthritis counterparts and may reflect a poor understanding of the role of FAI as a generator of chronic hip pain in the young patient. Given that the most common prescriber of opioids is not an orthopaedist, it is feasible that the opioid prescriber is simply unaware of the subspecialty surgical treatment options and is aiming to temporize the poorly understood hip pain.…”

Section: Discussionmentioning

confidence: 99%

Association of Preoperative Opioid Use With Complication Rates and Resource Use in Patients Undergoing Hip Arthroscopy for Femoroacetabular Impingement

Nazzal

Wilson

Farley

et al. 2021

Orthopaedic Journal of Sports Medicine

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Background: Preoperative opioid use has been shown to be a negative predictor of patient outcomes, complication rates, and resource utilization in a variety of different orthopaedic procedures. To date, there are no studies investigating its effect on outcomes after hip arthroscopy in the setting of femoroacetabular impingement (FAI). Purpose: To determine the association of preoperative opioid use with postoperative outcomes after hip arthroscopy in patients with FAI. Study Design: Cohort study; Level of evidence, 3. Methods: The Truven Health MarketScan Commercial Claims and Encounters Database was queried for all patients who underwent hip arthroscopy for FAI between 2011 and 2018. Opioid prescriptions filled in the 6 months preceding surgery were queried, and the average daily oral morphine equivalents (OMEs) in this period were computed for each patient. Patients were divided into 4 cohorts: opioid naïve, <1 OME per day, 1 to 5 OMEs per day, and >5 OMEs per day. Postoperative 90-day complications, health care utilization, perioperative costs, postoperative opioid use, and 1- and 3-year revision rates were then compared among cohorts. Results: A total of 22,124 patients were ultimately included in this study; 31.2% of these patients were prescribed opioids preoperatively. Overall, the percentage of preoperative opioid-naïve patients increased from 64.5% in 2011 to 78.9% in 2018. Patients who received preoperative opioids had a higher rate of complications, increased resource utilization, and increased revision rates. Specifically, on multivariate analysis, patients taking >5 OMEs per day (compared with patients who were preoperatively opioid naïve) had increased odds of a postoperative emergency department visit (Odds Ratio, 2.23; 95% confidence interval [CI], 1.94-2.56; P < .001), 90-day readmission (OR, 2.25; 95% CI, 1.77-2.87; P < .001), increased acute postoperative opioid use (OR, 25.56; 95% CI, 22.98-28.43; P < .001), prolonged opioid use (OR, 10.45; 95% CI, 8.92-12.25; P < .001), and 3-year revision surgery (OR, 2.14; 95% CI, 1.36-3.36; P < .001). Perioperative adjusted costs were increased for all preoperative opioid users and were highest for the >5 OMEs per day cohort ($6255; 95% CI, $5143-$7368). Conclusion: A large number of patients with FAI are prescribed opioids before undergoing hip arthroscopy, and use of these pain medications is associated with increased health care utilization, increased costs, prolonged opioid use, and early revision surgery.

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Effects of preoperative opioid education on postoperative opioid use and pain management in orthopaedics: A systematic review

Cited by 39 publications

References 24 publications

Opioid use among veterans undergoing major joint surgery managed by a multidisciplinary transitional pain service

Opioid use among veterans undergoing major joint surgery managed by a multidisciplinary transitional pain service

Perioperative Pain Management and Opioid Stewardship: A Practical Guide

Association of Preoperative Opioid Use With Complication Rates and Resource Use in Patients Undergoing Hip Arthroscopy for Femoroacetabular Impingement

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