Patients' Experience With Opioid Pain Medication After Discharge From Surgery: A Mixed-Methods Study

• Published in: The Journal of surgical research 2020-12, Vol.256, p.328-337
• Main Authors: Pius, Alexa K., Jones, Ethan, Bonnell, Levi N., Fujii, Mayo H., MacLean, Charles D.
• Format: Article
• Language: English
• Subjects: Academic Medical Centers - statistics & numerical data; Adult; Aged; Analgesics, Opioid - adverse effects; Drug Prescriptions - statistics & numerical data; Drug utilization; Drug Utilization - statistics & numerical data; Female; Health Knowledge, Attitudes, Practice; Humans; Male; Middle Aged; Opioid Epidemic - prevention & control; Opioids; Pain Management - methods; Pain Management - psychology; Pain Management - standards; Pain Measurement - statistics & numerical data; Pain, Postoperative - diagnosis; Pain, Postoperative - epidemiology; Pain, Postoperative - etiology; Patient Discharge; Patient Preference - statistics & numerical data; Postoperative pain; Practice Guidelines as Topic; Practice Patterns, Physicians' - standards; Practice Patterns, Physicians' - statistics & numerical data; Prescribing patterns; Qualitative Research; Retrospective Studies; Surgery; Surgical procedures; Surveys and Questionnaires - statistics & numerical data; Treatment Outcome; United States
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2020.06.026

Decreasing the number of prescription opioids has been a leading strategy in combating the opioid epidemic. In Vermont, statewide and institutional policies have affected prescribing practices, resulting in a 40% decrease in postoperative opioid prescribing. The optimal approach to postoperative opioid prescribing remains unknown. In this study, we describe patients' experience with pain control 1 wk after discharge from surgery. We assessed patients' experience using a telephone questionnaire, 1-wk after discharge after undergoing common surgical procedures between 2017 and 2019 at an academic medical center (n = 1027). Scaled responses regarding pain control, opioids prescribed, and opioids used (response rate 96%) were analyzed using a mixed-methods approach; open-ended patient responses to questions regarding whether the number of opioids prescribed was “correct” were analyzed using qualitative content analysis. One week after discharge, 96% of patients reported that their pain was well controlled. When asked whether they received the correct number of opioid pills postoperatively, qualitative analysis of patient responses yielded the following six themes: (1) I had more than I needed, but not more than I wanted; (2) Rationed medication; (3) Medication was not effective; (4) Caution regarding risks of opioids; (5) Awareness of the public health concerns; and (6) Used opioids from a prior prescription. Patient-reported pain control after common surgical procedures was excellent. However, patients are supportive of receiving more pain medications than they actually use, and they fear that further restrictions may prevent them or others from managing pain adequately. Understanding the patients' perspective is important for surgical education and improving discharge protocols.