• Karim S Ladha, Kathak Vachhani, Gretchen Gabriel, Rasheeda Darville, Karl Everett, Jodi M Gatley, Refik Saskin, Dorothy Wong, Praveen Ganty, Rita Katznelson, Alexander Huang, Joseph Fiorellino, Diana Tamir, Maxwell Slepian, Joel Katz, and Hance Clarke.
• Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada.
• Reg Anesth Pain Med. 2024 Sep 2; 49 (9): 650655650-655.

IntroductionIt has been well described that a small but significant proportion of patients continue to use opioids months after surgical discharge. We sought to evaluate postdischarge opioid use of patients who were seen by a Transitional Pain Service compared with controls.MethodsWe conducted a retrospective cohort study using administrative data of individuals who underwent surgery in Ontario, Canada from 2014 to 2018. Matched cohort pairs were created by matching Transitional Pain Service patients to patients of other academic hospitals in Ontario who were not enrolled in a Transitional Pain Service. Segmented regression was performed to assess changes in monthly mean daily opioid dosage.ResultsA total of 209 Transitional Pain Service patients were matched to 209 patients who underwent surgery at other academic centers. Over the 12 months after surgery, the mean daily dose decreased by an estimated 3.53 morphine milligram equivalents (95% CI 2.67 to 4.39, p<0.001) per month for the Transitional Pain Service group, compared with a decline of only 1.05 morphine milligram equivalents (95% CI 0.43 to 1.66, p<0.001) for the controls. The difference-in-difference change in opioid use for the Transitional Pain Service group versus the control group was -2.48 morphine milligram equivalents per month (95% CI -3.54 to -1.43, p=0.003).DiscussionPatients enrolled in the Transitional Pain Service were able to achieve opioid dose reduction faster than in the control cohorts. The difficulty in finding an appropriate control group for this retrospective study highlights the need for future randomized controlled trials to determine efficacy.© American Society of Regional Anesthesia & Pain Medicine 2024. No commercial re-use. See rights and permissions. Published by BMJ.

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