P. Moolchandani1, D. Kumar1, S. McGriff1, E. Alore1, M. A. Davis1, J. Ward1, S. Gordy1, J. W. Suliburk1, M. Hoffman1 1Baylor College Of Medicine,Houston, TX, USA
Introduction: Use and abuse of narcotic pain medicine has come to the forefront of the national healthcare crisis. Post-surgical patients experience acute pain as a result of their operation and require appropriate pain management. The amount and degree of ambulatory medications prescribed is variable and there is little data to guide physicians. The purpose of this study was to evaluate post-operative pain after routine laparoscopic appendectomy or cholecystectomy via patient reported outcome scores. We hypothesized that improved ambulatory collection of patient reported data would facilitate better understanding of patient pain management needs.
Methods: We prospectively enrolled 39 patients: 15 patients undergoing laparoscopic appendectomy and 24 undergoing cholecystectomy as a result of urgent admission. A cloud-based SMS platform was used to obtain patient reported outcomes on pain each day for 10 days post discharge. Patients were asked via text message to report their pain 0 – 10 each day, with 10 being the worst. Discharge physicians were blinded to patient enrollment in the study. Type and amount of discharge pain medication, demographics, need for readmission, return to emergency department, 30-day complications, and need for additional pain medication at clinic follow up were recorded.
Results: Average age was 36 + 9 years, 64% female. For non-complicated laparoscopic appendectomy and cholecystectomy, there was a downward trend in average pain score per day for the first 10 days, with a large decrease from day 3 to day 4 (Table 1). Patient response rate declined by 30% from day 1 to day 10 (Table 1). Practitioners uniformly prescribed tramadol at discharge with 92% of patients receiving a 3.75 day supply and 8% receiving a 7.5 day supply. In our cohort, there were 2 patients with complications (nausea, wound infection), each returning to the ED and one requiring readmission. There were no patients who required additional pain medication at clinic.
Conclusion: Patients post-appendectomy had consistently higher levels of pain postoperatively. However, both groups reported a substantial decrease in pain score on post discharge day 4. In this study, the majority of prescribing patterns observed adequately reflected patient reported pain needs. This data supports a short duration of prescription non-oxycodone/non-hydrocodone containing pain medications to cover 4 days post discharge in order to sufficiently manage postoperative pain. This approach can easily be used to determine ambulatory needs of patients undergoing other types of surgery to generate specific data to assist providers with optimal prescribing post-surgery.
