Patient-Reported Opioid Consumption and Pain Intensity After Common Orthopedic and Urologic Surgical Procedures With Use of an Automated Text Messaging System

• Published in: JAMA network open 2021-03, Vol.4 (3), p.e213243-e213243
• Main Authors: 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
• Format: Article
• Language: English
• Subjects: Adult; Aged; Analgesics, Opioid - pharmacology; Automation; Decision making; Female; Humans; Male; Middle Aged; Narcotics; Online Only; Original Investigation; Orthopedic Procedures - adverse effects; Orthopedics; Pain management; Pain, Postoperative - drug therapy; Patient Reported Outcome Measures; Patients; Quality Improvement; Surgery; Text Messaging; Urologic Surgical Procedures - adverse effects
• ISSN: 2574-3805; 2574-3805
• DOI: 10.1001/jamanetworkopen.2021.3243

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. 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. 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. 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. 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]