C. Johnson Jr.1, I. Marques1, A. Liwo1, L. Wood1, L. Goss1, J. Richman1, E. Malone1, J. Cannon1, M. Morris1, G. Kennedy1, D. Chu1 1University Of Alabama at Birmingham,Division Of Gastrointestinal Surgery,Birmingham, Alabama, USA
Introduction: Opioids are commonly used in post-discharge pain management. Patient perspectives and behaviors in the post-discharge setting are poorly understood however, and may be important to consider in efforts to reduce over-prescription of opioids. We aimed to characterize patient perspectives and behaviors with post-discharge pain management after major colorectal surgery.
Methods: Patients undergoing colorectal surgery were recruited at their 2-week follow-up appointment from October 2017 to April 2018 at a single institution. Participants were surveyed with a six-item questionnaire focused on the use, perspectives and perceived adequacy of post-discharge pain management. Patient demographics, hospital length of stay (LOS) and 30-day readmissions were recorded. Patients were stratified into two groups: perceived adequate vs. non-adequate pain control. A comparison of age, race, baseline pain medication, a request of additional pain medicine at post-operative follow-up, type of discharge pain medication, hospital LOS and 30-day readmission was performed between the two groups. Statistical analysis was done using Fishers’s exact tests and t-tests.
Results:
58 patients completed the surveys. The majority of patients in this study were white (71%), and were not on baseline pain medication (56%); half were female (50%) and a plurality had private insurance (47%). The most commonly prescribed medication was a high potency pain medication (Oxycodone, Percocet or Norco; 77%) with the remainder receiving tramadol alone (17%), or a combination of an opioid medication and tramadol (6.4%). Inadequate pain control was reported in 14% of patients. There was no difference in race, baseline pain medication, request of additional pain prescriptions at the follow-up appointment, LOS, or 30-day readmission between patients that had their pain controlled vs patients that did not. Individuals who thought their pain was not managed properly were more likely to have been discharged with a high potency prescription (100% vs 66% p = 0.003) and more likely to be younger (mean 45.9 vs 60.7, p=0.01).
Conclusion:
The majority of patients reported adequate postoperative pain control. Patients who reported inadequate pain control were younger and more likely to receive higher potency prescription at discharge. No association was found between race, length of stay or readmission rates and patient’s perspective on post-operative pain control. Additional research is needed to understand the reasoning that underscores high potency discharge pain medication prescriptions in some patients and how age impacts a patient’s perspective on pain management.