Cornelius A. Thiels, DO, MBA, on Opioid Prescription Guidelines After Surgery

Research presented at the virtual American College of Surgeons Clinical Congress 2020 reported that guidelines to reduce the number of opioids prescribed to patients following surgery may be missing a small group of patients that need a greater level of pain control.

“The key findings of our study are that we were able to successfully reduce how many opioids we were prescribing for patients after operations using evidence-based guidelines, and that the reduction resulted in less unused opioids remaining in our community,” lead study author Cornelius A. Thiels, DO, MBA, a surgical oncology fellow at Memorial Sloan Kettering Cancer Center, New York, and a researcher at Mayo Clinic, Rochester, Minnesota, where the study was conducted, said in a press release. “But, importantly, that reduction also resulted in the majority of patients being overall still satisfied with their pain control after discharge and not needing more refills than if they were to get more opioids, as would have been the case in the past.”

“However, the other finding of our research is that there’s still additional room to improve in terms of making sure all patients after surgery have their pain well controlled,” Thiels continued, “because we believe there is a small subset of patients who have lower pain scores with the reduced opioid prescribing guidelines.”

In this study, researchers assessed 138 patients who underwent 1 of 12 elective operations from May 2019 to November 2019, after Mayo Clinic adopted the evidence-based opioid prescribing guidelines in early 2018. Those findings were then compared with 603 patients who had the same procedures performed before the guidelines, from March 2017 to January 2018. Of note, none of the patients in the study were taking opioids prior to surgery.

On a scale of 0 to 10, overall patient-reported pain control was found to be worse post-guideline versus pre-guideline (8 vs. 9 [a lower score represents worse pain control]; P = .002). In addition, the percentage of patients who were very or somewhat dissatisfied with their pain control more than doubled post-guideline (9.4% vs. 4.2%; P = .04), as did the percentage who indicated they were not prescribed enough pain medications after discharge (12.5% vs. 4.9%; P = .002).

In an interview with CancerNetwork®, Thiels discussed the study findings further, as well as what how he recommends providers should handle opioid prescription.

This segment comes from the CancerNetwork® portion of the MJH Life Sciences Medical World News, airing daily on all MJH Life Sciences channels.

Reference:

Study shows need for balance in post-surgery opioid prescribing guidelines [news release]. Chicago. Published October 3, 2020. Accessed October 12, 2020.