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Opioid Consumption Following Outpatient Plastic Surgery Procedures
Stacy Henderson, M.D., Brittany Behar, M.D., Brett Michelotti, M.D., William Albright, M.D., John Potochny, M.D..
Penn State Milton S. Hershey Medical Center, Hershey, PA, USA.
BACKGROUND: A rise in opioid abuse has led to increases in dependency, overdose and healthcare resource utilization. Methods to reduce the frequency with which opioids are prescribed are being investigated across multiple disciplines. Currently, there are no data detailing the need for opioids in post-operative pain management following outpatient Plastic Surgery procedures. The goal of this study was to evaluate patient satisfaction, opioid consumption, and physician prescribing practices following outpatient Plastic Surgery procedures in order to provide evidence-based strategies for post-operative pain control.
METHODS: Patients who underwent outpatient Plastic Surgery procedures were identified at their first post-operative visit, between 7 and 14 days (+/- 3 days). Included were all English-speaking patients aged 18 to 90 who underwent elective, outpatient reconstructive procedures. Patients undergoing cosmetic procedures as well as those with pre-existing pain disorders were excluded. Patients were asked to complete a tablet-based survey in which they were queried on overall satisfaction with pain control, highest post-operative pain level, current pain level, number of days requiring opioid pain medication, reason for discontinuing medication, use of non-opioid medication for pain control, adverse effects, number of tablets consumed, and number of tablets remaining. Responses were also stratified by type of procedure performed.
RESULTS: Fifty-two patients completed the survey. The majority of patients (88.5%) reported overall satisfaction with their pain control regimen. On a numeric rating scale of 1-10, the average worst post-operative pain score was 6.6. The average pain score at the first post-operative visit was 2.6. Less than half of patients (39.2%) were still taking narcotic pain medication at the time of their first visit, with 64.3% discontinuing opioid pain medications between post-operative days 1 and 7. Opioid pain medication was discontinued in 58.6% of patients because they no longer had pain, in 20.7% because they had mild pain controlled with other analgesics, in 13.8% because they ran out of medication, and in 6.9% because they experienced intolerable side effects. About one-third of patients were still taking narcotic medication 14 or more days after surgery (31%) and required prescription refills (30%). The average number of tablets prescribed was 30, while the average number of tablets consumed was 14.
CONCLUSION: A balance between pain control and responsible prescribing of narcotic pain medications must be achieved. Our study surveyed patients on their satisfaction with post-operative pain control and consumption of opioid pain medications. In most cases, pain was well-controlled post-operatively with high rates of patient satisfaction. However, on average, patients received nearly twice the amount of pain medications that were used. This study can be used to guide prescribing practices of narcotic analgesics amongst Plastic Surgeons.
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