• J. Thorac. Cardiovasc. Surg. · Feb 2020

    Preemptive pain-management program is associated with reduction of opioid prescriptions after benign minimally invasive foregut surgery.

    • Min P Kim, Carla Godoy, Duc T Nguyen, Leonora M Meisenbach, Ray Chihara, Edward Y Chan, and Edward A Graviss.
    • Division of Thoracic Surgery, Department of Surgery, Houston Methodist Hospital, Houston, Tex; Department of Surgery, Weill Cornell Medical College, Houston Methodist Hospital, Houston, Tex. Electronic address: mpkim@houstonmethodist.org.
    • J. Thorac. Cardiovasc. Surg. 2020 Feb 1; 159 (2): 734-744.e4.

    ObjectiveThe opioid crisis is partly due to opioids prescribed after elective surgery. We sought to determine if a preemptive pain-management program would be associated with opioid-free discharge after benign foregut surgery.MethodsA retrospective case-control study of prospectively collected data was conducted at a single institution of patients who underwent elective minimally invasive benign foregut surgery. We compared the outcomes among patients who were managed with standard care (control), enhanced recovery after surgery alone, or a preemptive pain-management program with enhanced recovery after surgery.ResultsAmong 414 patients, there were significantly fewer opioid medication prescriptions at discharge (9.6% vs 85.2% vs 87%, P < .001) and fewer postoperative complications (3.2% vs 14.8% vs 15.1%, P = .004) in the preemptive pain-management group (n = 94), enhanced recovery after surgery alone (n = 81), and the control group (n = 239), respectively. Multivariable logistic regression analysis showed that the preemptive pain-management program was a factor associated with a decrease in opioid medication prescriptions at discharge (odds ratio, 0.01; 95% confidence interval, 0.01-0.03; P < .001), as well as a decrease in complications after surgery (odds ratio, 0.22; 95% confidence interval, 0.06-0.79; P = .02). Moreover, in the preemptive pain-management group, average self-reported pain level in a subset of patients at 30 days after surgery was 0.9 ± 1.4 on a 0- to 10-point pain scale.ConclusionsThe preemptive pain-management program was associated with opioid-free discharge after minimally invasive foregut surgery. This study provides a strategy to reduce opioid prescriptions after foregut surgery and, if implemented nationally, could decrease the amount of opioids used in the community.Copyright © 2019 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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