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Patients just as satisfied when surgeons give fewer opioids for pain

[November 13, 2019] By Vishwadha Chander

(Reuters Health) - When surgeons cut their prescribing of opioids for pain by more than 50%, their patient-satisfaction scores didn't suffer, a small U.S. study found.

As reported in JAMA Surgery, the study team analyzed patient satisfaction results for 11 surgeons during the periods before and after the doctors were given education and prescribing guidelines that led to a sharp decrease in the number and duration of opioid prescriptions they gave out. Patient satisfaction ratings were high before the intervention and unchanged afterward, the study found.

"Our previous research looked at how much opioid was being prescribed and how many patients actually used it," said Dr. Richard Barth of the Geisel School of Medicine and Dartmouth Hitchcock Medical Center in Hanover, New Hampshire, the study's senior author. That earlier work showed patients were being prescribed more opioids than they used.

Opioid prescription guidelines exist, Barth said in a phone interview. "We wanted to find out if there are barriers surgeons faced to following these guidelines."

Public health officials in the U.S. consider opioid overdoses to be at crisis levels and are seeking ways to reduce opioid prescribing whenever possible.

Barth's team analyzed prescribing practices and patient satisfaction for 11 surgeons who performed a total of 996 surgeries during the study period. The researchers focused on five common procedures: partial mastectomies with or without lymph node removal, minimally invasive gallbladder removal, and either open or minimally invasive hernia repair.

They looked at data for May to December 2015 and July 2016 to June 2017. In April and May 2016, the authors had educated clinicians at their institution about opioid prescribing guidelines for each of the surgeries in the analysis.

In the second study period, after the educational intervention, all of the surgeons decreased the average number of pills they prescribed, with 10 of the 11 reducing by 50% or more. And while 90.2% of patients were prescribed opioids in the first period, that dropped to 72.8% in the second period.

When researchers looked at satisfaction ratings from patients, they found that scores before the intervention averaged 9.7 out of a possible positive rating of 10, and afterward, the average score was 9.65. Further analysis found no significant change in satisfaction rating for any individual doctor.

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"We showed we could dramatically decrease opioid prescription and there was no change in patient satisfaction levels," Barth said.

Results from satisfaction surveys can influence healthcare practices, and it's widely acknowledged that patients who have felt their pain was not adequately treated have given hospitals poor scores, said Dr. Steven Cohen, a pain medicine specialist at Johns Hopkins School of Medicine in Baltimore, Maryland, and at Walter Reed National Military Medical Center.

"The scores have affected reimbursement and hospital ratings," Cohen, who was not involved in the study, said in a phone interview.

But people realize now that this could be contributing to the opioid crisis, he added. "People mistook the need to address pain to mean taking opioids, and this misunderstanding contributed to the opioid crisis."

It's important for doctors to set patients' expectations, Barth said. "We can tell our patients there will be discomfort, and we can manage pain without opioids."

Cohen pointed out that patients most likely to be on opioids are the ones having surgery for chronic pain – not the kinds of surgeries examined in the current study.

"If the authors looked at complicated surgeries, they may have had a different result with giving people less opioid," Cohen said.

Another limitation of the study, the authors acknowledge, is that the results are from a single institution.

Still, Barth said, the results should encourage surgeons not to worry about ratings as long as they discuss pain management, tell their patients they care and partner with them to manage pain without opioids.

SOURCE: https://bit.ly/36HwzKw JAMA Surgery, online October 16, 2019.

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