Cargando…
Patient-Reported Opioid Consumption and Pain Intensity After Common Orthopedic and Urologic Surgical Procedures With Use of an Automated Text Messaging System
IMPORTANCE: Surgeons must balance management of acute postoperative pain with opioid stewardship. Patient-centered methods that immediately evaluate pain and opioid consumption can be used to guide prescribing and shared decision-making. OBJECTIVE: To assess the difference between the number of opio...
Autores principales: | , , , , , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
American Medical Association
2021
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7994954/ https://www.ncbi.nlm.nih.gov/pubmed/33764425 http://dx.doi.org/10.1001/jamanetworkopen.2021.3243 |
_version_ | 1783669863627096064 |
---|---|
author | Agarwal, Anish K. Lee, Daniel Ali, Zarina Sennett, Brian Xiong, Ruiying Hemmons, Jessica Spencer, Evan Abdel-Rahman, Dina Kleinman, Rachel Lacko, Hannah Horan, Annamarie Dooley, Mary Hume, Eric Mehta, Samir Delgado, M. Kit |
author_facet | Agarwal, Anish K. Lee, Daniel Ali, Zarina Sennett, Brian Xiong, Ruiying Hemmons, Jessica Spencer, Evan Abdel-Rahman, Dina Kleinman, Rachel Lacko, Hannah Horan, Annamarie Dooley, Mary Hume, Eric Mehta, Samir Delgado, M. Kit |
author_sort | Agarwal, Anish K. |
collection | PubMed |
description | IMPORTANCE: Surgeons must balance management of acute postoperative pain with opioid stewardship. Patient-centered methods that immediately evaluate pain and opioid consumption can be used to guide prescribing and shared decision-making. OBJECTIVE: To assess the difference between the number of opioid tablets prescribed and the self-reported number of tablets taken as well as self-reported pain intensity and ability to manage pain after orthopedic and urologic procedures with use of an automated text messaging system. DESIGN, SETTING, AND PARTICIPANTS: This quality improvement study was conducted at a large, urban academic health care system in Pennsylvania. Adult patients (aged ≥18 years) who underwent orthopedic and urologic procedures and received postoperative prescriptions for opioids were included. Data were collected prospectively using automated text messaging until postoperative day 28, from May 1 to December 31, 2019. MAIN OUTCOMES AND MEASURES: The primary outcome was the difference between the number of opioid tablets prescribed and the patient-reported number of tablets taken (in oxycodone 5-mg tablet equivalents). Secondary outcomes were self-reported pain intensity (on a scale of 0-10, with 10 being the highest level of pain) and ability to manage pain (on a scale of 0-10, with 10 representing very able to control pain) after orthopedic and urologic procedures. RESULTS: Of the 919 study participants, 742 (80.7%) underwent orthopedic procedures and 177 (19.2%) underwent urologic procedures. Among those who underwent orthopedic procedures, 384 (51.8%) were women, 491 (66.7%) were White, and the median age was 48 years (interquartile range [IQR], 32-61 years); 514 (69.8%) had an outpatient procedure. Among those who underwent urologic procedures, 145 (84.8%) were men, 138 (80.7%) were White, and the median age was 56 years (IQR, 40-67 years); 106 (62%) had an outpatient procedure. The mean (SD) pain score on day 4 after orthopedic procedures was 4.72 (2.54), with a mean (SD) change by day 21 of −0.40 (1.91). The mean (SD) ability to manage pain score on day 4 was 7.32 (2.59), with a mean (SD) change of −0.80 (2.72) by day 21. The mean (SD) pain score on day 4 after urologic procedures was 3.48 (2.43), with a mean (SD) change by day 21 of −1.50 (2.12). The mean (SD) ability to manage pain score on day 4 was 7.34 (2.81), with a mean (SD) change of 0.80 (1.75) by day 14. The median quantity of opioids prescribed for patients who underwent orthopedic procedures was high compared with self-reported consumption (20 tablets [IQR, 15-30 tablets] vs 6 tablets used [IQR, 0-14 tablets]), similar to findings for patients who underwent urologic procedures (7 tablets [IQR, 5-10 tablets] vs 1 tablet used [IQR, 0-4 tablets]). Over the study period, 9452 of 15 581 total tablets prescribed (60.7%) were unused. A total of 589 patients (64.1%) used less than half of the amount prescribed, and 256 patients (27.8%) did not use any opioids (179 [24.1%] who underwent orthopedic procedures and 77 [43.5%] who underwent urologic procedures). CONCLUSIONS AND RELEVANCE: In this quality improvement study of adult patients reporting use of opioids after common orthopedic and urologic surgical procedures through a text messaging system, the quantities of opioids prescribed and the quantity consumed differed. Patient-reported data collected through text messaging may support clinicians in tailoring prescriptions and guide shared decision-making to limit excess quantities of prescribed opioids. |
format | Online Article Text |
id | pubmed-7994954 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | American Medical Association |
record_format | MEDLINE/PubMed |
spelling | pubmed-79949542021-04-12 Patient-Reported Opioid Consumption and Pain Intensity After Common Orthopedic and Urologic Surgical Procedures With Use of an Automated Text Messaging System Agarwal, Anish K. Lee, Daniel Ali, Zarina Sennett, Brian Xiong, Ruiying Hemmons, Jessica Spencer, Evan Abdel-Rahman, Dina Kleinman, Rachel Lacko, Hannah Horan, Annamarie Dooley, Mary Hume, Eric Mehta, Samir Delgado, M. Kit JAMA Netw Open Original Investigation IMPORTANCE: Surgeons must balance management of acute postoperative pain with opioid stewardship. Patient-centered methods that immediately evaluate pain and opioid consumption can be used to guide prescribing and shared decision-making. OBJECTIVE: To assess the difference between the number of opioid tablets prescribed and the self-reported number of tablets taken as well as self-reported pain intensity and ability to manage pain after orthopedic and urologic procedures with use of an automated text messaging system. DESIGN, SETTING, AND PARTICIPANTS: This quality improvement study was conducted at a large, urban academic health care system in Pennsylvania. Adult patients (aged ≥18 years) who underwent orthopedic and urologic procedures and received postoperative prescriptions for opioids were included. Data were collected prospectively using automated text messaging until postoperative day 28, from May 1 to December 31, 2019. MAIN OUTCOMES AND MEASURES: The primary outcome was the difference between the number of opioid tablets prescribed and the patient-reported number of tablets taken (in oxycodone 5-mg tablet equivalents). Secondary outcomes were self-reported pain intensity (on a scale of 0-10, with 10 being the highest level of pain) and ability to manage pain (on a scale of 0-10, with 10 representing very able to control pain) after orthopedic and urologic procedures. RESULTS: Of the 919 study participants, 742 (80.7%) underwent orthopedic procedures and 177 (19.2%) underwent urologic procedures. Among those who underwent orthopedic procedures, 384 (51.8%) were women, 491 (66.7%) were White, and the median age was 48 years (interquartile range [IQR], 32-61 years); 514 (69.8%) had an outpatient procedure. Among those who underwent urologic procedures, 145 (84.8%) were men, 138 (80.7%) were White, and the median age was 56 years (IQR, 40-67 years); 106 (62%) had an outpatient procedure. The mean (SD) pain score on day 4 after orthopedic procedures was 4.72 (2.54), with a mean (SD) change by day 21 of −0.40 (1.91). The mean (SD) ability to manage pain score on day 4 was 7.32 (2.59), with a mean (SD) change of −0.80 (2.72) by day 21. The mean (SD) pain score on day 4 after urologic procedures was 3.48 (2.43), with a mean (SD) change by day 21 of −1.50 (2.12). The mean (SD) ability to manage pain score on day 4 was 7.34 (2.81), with a mean (SD) change of 0.80 (1.75) by day 14. The median quantity of opioids prescribed for patients who underwent orthopedic procedures was high compared with self-reported consumption (20 tablets [IQR, 15-30 tablets] vs 6 tablets used [IQR, 0-14 tablets]), similar to findings for patients who underwent urologic procedures (7 tablets [IQR, 5-10 tablets] vs 1 tablet used [IQR, 0-4 tablets]). Over the study period, 9452 of 15 581 total tablets prescribed (60.7%) were unused. A total of 589 patients (64.1%) used less than half of the amount prescribed, and 256 patients (27.8%) did not use any opioids (179 [24.1%] who underwent orthopedic procedures and 77 [43.5%] who underwent urologic procedures). CONCLUSIONS AND RELEVANCE: In this quality improvement study of adult patients reporting use of opioids after common orthopedic and urologic surgical procedures through a text messaging system, the quantities of opioids prescribed and the quantity consumed differed. Patient-reported data collected through text messaging may support clinicians in tailoring prescriptions and guide shared decision-making to limit excess quantities of prescribed opioids. American Medical Association 2021-03-25 /pmc/articles/PMC7994954/ /pubmed/33764425 http://dx.doi.org/10.1001/jamanetworkopen.2021.3243 Text en Copyright 2021 Agarwal AK et al. JAMA Network Open. http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the CC-BY License. |
spellingShingle | Original Investigation Agarwal, Anish K. Lee, Daniel Ali, Zarina Sennett, Brian Xiong, Ruiying Hemmons, Jessica Spencer, Evan Abdel-Rahman, Dina Kleinman, Rachel Lacko, Hannah Horan, Annamarie Dooley, Mary Hume, Eric Mehta, Samir Delgado, M. Kit Patient-Reported Opioid Consumption and Pain Intensity After Common Orthopedic and Urologic Surgical Procedures With Use of an Automated Text Messaging System |
title | Patient-Reported Opioid Consumption and Pain Intensity After Common Orthopedic and Urologic Surgical Procedures With Use of an Automated Text Messaging System |
title_full | Patient-Reported Opioid Consumption and Pain Intensity After Common Orthopedic and Urologic Surgical Procedures With Use of an Automated Text Messaging System |
title_fullStr | Patient-Reported Opioid Consumption and Pain Intensity After Common Orthopedic and Urologic Surgical Procedures With Use of an Automated Text Messaging System |
title_full_unstemmed | Patient-Reported Opioid Consumption and Pain Intensity After Common Orthopedic and Urologic Surgical Procedures With Use of an Automated Text Messaging System |
title_short | Patient-Reported Opioid Consumption and Pain Intensity After Common Orthopedic and Urologic Surgical Procedures With Use of an Automated Text Messaging System |
title_sort | patient-reported opioid consumption and pain intensity after common orthopedic and urologic surgical procedures with use of an automated text messaging system |
topic | Original Investigation |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7994954/ https://www.ncbi.nlm.nih.gov/pubmed/33764425 http://dx.doi.org/10.1001/jamanetworkopen.2021.3243 |
work_keys_str_mv | AT agarwalanishk patientreportedopioidconsumptionandpainintensityaftercommonorthopedicandurologicsurgicalprocedureswithuseofanautomatedtextmessagingsystem AT leedaniel patientreportedopioidconsumptionandpainintensityaftercommonorthopedicandurologicsurgicalprocedureswithuseofanautomatedtextmessagingsystem AT alizarina patientreportedopioidconsumptionandpainintensityaftercommonorthopedicandurologicsurgicalprocedureswithuseofanautomatedtextmessagingsystem AT sennettbrian patientreportedopioidconsumptionandpainintensityaftercommonorthopedicandurologicsurgicalprocedureswithuseofanautomatedtextmessagingsystem AT xiongruiying patientreportedopioidconsumptionandpainintensityaftercommonorthopedicandurologicsurgicalprocedureswithuseofanautomatedtextmessagingsystem AT hemmonsjessica patientreportedopioidconsumptionandpainintensityaftercommonorthopedicandurologicsurgicalprocedureswithuseofanautomatedtextmessagingsystem AT spencerevan patientreportedopioidconsumptionandpainintensityaftercommonorthopedicandurologicsurgicalprocedureswithuseofanautomatedtextmessagingsystem AT abdelrahmandina patientreportedopioidconsumptionandpainintensityaftercommonorthopedicandurologicsurgicalprocedureswithuseofanautomatedtextmessagingsystem AT kleinmanrachel patientreportedopioidconsumptionandpainintensityaftercommonorthopedicandurologicsurgicalprocedureswithuseofanautomatedtextmessagingsystem AT lackohannah patientreportedopioidconsumptionandpainintensityaftercommonorthopedicandurologicsurgicalprocedureswithuseofanautomatedtextmessagingsystem AT horanannamarie patientreportedopioidconsumptionandpainintensityaftercommonorthopedicandurologicsurgicalprocedureswithuseofanautomatedtextmessagingsystem AT dooleymary patientreportedopioidconsumptionandpainintensityaftercommonorthopedicandurologicsurgicalprocedureswithuseofanautomatedtextmessagingsystem AT humeeric patientreportedopioidconsumptionandpainintensityaftercommonorthopedicandurologicsurgicalprocedureswithuseofanautomatedtextmessagingsystem AT mehtasamir patientreportedopioidconsumptionandpainintensityaftercommonorthopedicandurologicsurgicalprocedureswithuseofanautomatedtextmessagingsystem AT delgadomkit patientreportedopioidconsumptionandpainintensityaftercommonorthopedicandurologicsurgicalprocedureswithuseofanautomatedtextmessagingsystem |