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Reducing Opioid Use in Endocrine Surgery Through Patient Education and Provider Prescribing Patterns.
J Surg Res. 2020 12; 256:303-310.JS

Abstract

BACKGROUND

Postoperative opioid use can lead to dependence, contributing to the opioid epidemic in the United States. New persistent opioid use after minor surgeries occurs in 5.9% of patients. With increased documentation of persistent opioid use postoperatively, surgeons must pursue interventions to reduce opioid use perioperatively.

METHODS

We performed a prospective cohort study to assess the feasibility of a preoperative intervention via patient education or counseling and changes in provider prescribing patterns to reduce postoperative opioid use. We included adult patients undergoing thyroidectomy and parathyroidectomy from January 22, 2019 to February 28, 2019 at a tertiary referral, academic endocrine surgery practice. Surveys were administered to assess pain and patient satisfaction postoperatively. Prescription, demographic, and comorbidity data were collected from the electronic health record.

RESULTS

Sixty six patients (74.2% women, mean age 58.6 [SD 14.9] y) underwent thyroidectomy (n = 35), parathyroidectomy (n = 24), and other cervical endocrine operations (n = 7). All patients received a preoperative educational intervention in the form of a paper handout. 90.9% of patients were discharged with prescriptions for nonopioid pain medications, and 7.6% were given an opioid prescription on discharge. Among those who received an opioid prescription, the median quantity of opioids prescribed was 135 (IQR 120-150) oral morphine equivalents. On survey, four patients (6.1%) reported any postoperative opioid use, and 94.6% of patients expressed satisfaction with their preoperative education and postoperative pain management.

CONCLUSIONS

Clear and standardized education regarding postoperative pain management is feasible and associated with high patient satisfaction. Initiation of such education may support efforts to minimize unnecessary opioid prescriptions in the population undergoing endocrine surgery.

Authors+Show Affiliations

University of California- San Francisco, School of Medicine, San Francisco, California.Department of Surgery, University of California- San Francisco, San Francisco, California.Department of Anesthesia and Perioperative Care, University of California- San Francisco, San Francisco, California.Department of Anesthesia and Perioperative Care, University of California- San Francisco, San Francisco, California.Department of Anesthesia and Perioperative Care, University of California- San Francisco, San Francisco, California.Department of Surgery, Section of Endocrine Surgery, University of California- San Francisco, San Francisco, California.Department of Surgery, Section of Endocrine Surgery, University of California- San Francisco, San Francisco, California.Department of Surgery, Stanford University, Stanford, California. Electronic address: Cseib@stanford.edu.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

32712445

Citation

Kwan, Stephanie Y., et al. "Reducing Opioid Use in Endocrine Surgery Through Patient Education and Provider Prescribing Patterns." The Journal of Surgical Research, vol. 256, 2020, pp. 303-310.
Kwan SY, Lancaster E, Dixit A, et al. Reducing Opioid Use in Endocrine Surgery Through Patient Education and Provider Prescribing Patterns. J Surg Res. 2020;256:303-310.
Kwan, S. Y., Lancaster, E., Dixit, A., Inglis-Arkell, C., Manuel, S., Suh, I., Shen, W. T., & Seib, C. D. (2020). Reducing Opioid Use in Endocrine Surgery Through Patient Education and Provider Prescribing Patterns. The Journal of Surgical Research, 256, 303-310. https://doi.org/10.1016/j.jss.2020.06.025
Kwan SY, et al. Reducing Opioid Use in Endocrine Surgery Through Patient Education and Provider Prescribing Patterns. J Surg Res. 2020;256:303-310. PubMed PMID: 32712445.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Reducing Opioid Use in Endocrine Surgery Through Patient Education and Provider Prescribing Patterns. AU - Kwan,Stephanie Y, AU - Lancaster,Elizabeth, AU - Dixit,Anjali, AU - Inglis-Arkell,Christina, AU - Manuel,Solmaz, AU - Suh,Insoo, AU - Shen,Wen T, AU - Seib,Carolyn D, Y1 - 2020/07/23/ PY - 2020/02/18/received PY - 2020/05/31/revised PY - 2020/06/16/accepted PY - 2020/7/28/pubmed PY - 2021/3/13/medline PY - 2020/7/27/entrez KW - Endocrine surgery KW - Opioid KW - Pain control KW - Patient education SP - 303 EP - 310 JF - The Journal of surgical research JO - J Surg Res VL - 256 N2 - BACKGROUND: Postoperative opioid use can lead to dependence, contributing to the opioid epidemic in the United States. New persistent opioid use after minor surgeries occurs in 5.9% of patients. With increased documentation of persistent opioid use postoperatively, surgeons must pursue interventions to reduce opioid use perioperatively. METHODS: We performed a prospective cohort study to assess the feasibility of a preoperative intervention via patient education or counseling and changes in provider prescribing patterns to reduce postoperative opioid use. We included adult patients undergoing thyroidectomy and parathyroidectomy from January 22, 2019 to February 28, 2019 at a tertiary referral, academic endocrine surgery practice. Surveys were administered to assess pain and patient satisfaction postoperatively. Prescription, demographic, and comorbidity data were collected from the electronic health record. RESULTS: Sixty six patients (74.2% women, mean age 58.6 [SD 14.9] y) underwent thyroidectomy (n = 35), parathyroidectomy (n = 24), and other cervical endocrine operations (n = 7). All patients received a preoperative educational intervention in the form of a paper handout. 90.9% of patients were discharged with prescriptions for nonopioid pain medications, and 7.6% were given an opioid prescription on discharge. Among those who received an opioid prescription, the median quantity of opioids prescribed was 135 (IQR 120-150) oral morphine equivalents. On survey, four patients (6.1%) reported any postoperative opioid use, and 94.6% of patients expressed satisfaction with their preoperative education and postoperative pain management. CONCLUSIONS: Clear and standardized education regarding postoperative pain management is feasible and associated with high patient satisfaction. Initiation of such education may support efforts to minimize unnecessary opioid prescriptions in the population undergoing endocrine surgery. SN - 1095-8673 UR - https://www.unboundmedicine.com/medline/citation/32712445/Reducing_Opioid_Use_in_Endocrine_Surgery_Through_Patient_Education_and_Provider_Prescribing_Patterns_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-4804(20)30408-X DB - PRIME DP - Unbound Medicine ER -