Postdischarge Pain Management After Thoracic Surgery: A Patient-Centered Approach

Authors

Benjamin A. Abrams, Department of Anesthesiology, University of Colorado, Anschutz Medical Campus, Aurora, Colorado.
Kimberly A. Murray, Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, Portland, Maine.
Katharine Mahoney, Department of Anesthesiology, University of Colorado, Anschutz Medical Campus, Aurora, Colorado.
Kristen M. Raymond, Department of Psychiatry, University of Colorado, Anschutz Medical Campus, Aurora, Colorado.
Shannon K. McWilliams, Department of Psychiatry, University of Colorado, Anschutz Medical Campus, Aurora, Colorado.
Stephanie Nichols, Department of Pharmacy Practice, College of Pharmacy, University of New England, Portland, Maine.
Elham Mahmoudi, Department of Family Medicine, University of Michigan, Ann Arbor, Michigan.
Lena M. Mayes, Department of Anesthesiology, University of Colorado, Anschutz Medical Campus, Aurora, Colorado.
Ana Fernandez-Bustamante, Department of Anesthesiology, University of Colorado, Anschutz Medical Campus, Aurora, Colorado.
John D. Mitchell, Department of Surgery, University of Colorado, Anschutz Medical Campus, Aurora, Colorado.
Robert A. Meguid, Department of Surgery, University of Colorado, Anschutz Medical Campus, Aurora, Colorado.
Giorgio Zanotti, St. Vincent Hospital, Heart Center of Indiana, Indianapolis, Indiana.
Karsten Bartels

Document Type

Article

Publication Date

11-2020

Institution/Department

Surgery

Journal Title

The Annals of Thoracic Surgery

MeSH Headings

Aged; Aged, 80 and over; Analgesics, Opioid (therapeutic use); Female; Humans; Male; Middle Aged; Pain Management (methods); Pain, Postoperative (drug therapy); Patient-Centered Care (methods); Prospective Studies; Thoracic Surgical Procedures

Abstract

BACKGROUND: Postoperative analgesia is paramount to recovery after thoracic surgery, and opioids play an invaluable role in this process. However, current 1-size-fits-all prescribing practices produce large quantities of unused opioids, thereby increasing the risk of nonmedical use and overdose. This study hypothesized that patient and perioperative characteristics, including 24-hour before-discharge opioid intake, could inform more appropriate postdischarge prescriptions after thoracic surgery. METHODS: This prospective observational cohort study was conducted in 200 adult thoracic surgical patients. The cohort was divided into 3 groups on the basis of 24-hour before-discharge opioid intake in morphine milligram equivalents (MME): (1) no (0 MME), (2) low (>0 to ≤22.5 MME), or (3) high (>22.5 MME) before-discharge opioid intake. Logistic regression was used to analyze the association of patient and perioperative characteristics with self-reported after-discharge opioid use. RESULTS: Univariate analysis showed that preoperative opioid use, 24-hour before-discharge acetaminophen and gabapentinoid intake, and 24-hour before-discharge opioid intake were associated with higher after-discharge opioid use. Multivariable modeling demonstrated that 24-hour before-discharge opioid intake was most significantly associated with after-discharge opioid use. For example, compared with patients who took high amounts of opioids before discharge, patients who took no opioids before discharge were 99% less likely to take a high amount of opioids after discharge compared with taking none (odds ratio, 0.011; 95% confidence interval, 0.003 to 0.047; P < .001). CONCLUSIONS: Assessment of 24-hour before-discharge opioid intake may inform patient requirements after discharge. Opioid prescriptions after thoracic surgery can thereby be targeted on the basis of anticipated needs.

First Page

1714

Last Page

1721

Recommended Citation

Abrams BA, Murray KA, Mahoney K, et al. Postdischarge Pain Management After Thoracic Surgery: A Patient-Centered Approach. Ann Thorac Surg. 2020;110(5):1714-1721. doi:10.1016/j.athoracsur.2020.04.048