Section of Plastic Surgery, Department of Surgery, Michigan Medicine, Ann Arbor.
Department of Plastic Surgery, University of California, Irvine, School of Medicine, Orange.
JAMA Netw Open. 2021 Dec 1;4(12):e2140869. doi: 10.1001/jamanetworkopen.2021.40869.
Opioids are often prescribed after elective surgical treatment despite the potential for misuse. Although various pain control regimens exist, patient preferences for acute postoperative pain management are unknown.
To describe patient-reported key attributes of postoperative pain management.
DESIGN, SETTING, AND PARTICIPANTS: This decision analytical model used responses from a survey based on conjoint analysis to investigate the value patients placed on different aspects of postoperative pain management. Participants were patients aged 18 years or older who underwent elective hand surgical procedures between July 1, 2018, and July 23, 2019, at a single academic center. The survey was completed on a web-based platform and took place between November 2019 and January 2020. Data were analyzed from May through July 2021.
Participants were presented with a series of discrete-choice tasks and asked to select between 2 postoperative medication options that changed from question to question and had varying characteristics.
Attribute importance scores and part-worth utility values for the queried aspects of pain control were calculated.
Of 710 individuals invited, 321 (45.2%) completed the survey; there were 212 (66.0%) women and 108 (33.6%) men, and the most common age category was 60 to 69 years (102 participants [31.8%]). Most patients reported previous opioid use (282 individuals [87.9%]). Factors in the decision-making process with the highest attribute importance scores (SDs) were risk of addiction (26.3% [13.0%]) and amount of pain relief (25.6% [14.6%]). Adverse effects 13.9% (7.2%), functional independence 11.8% (7.3%), and level of trust in the prescriber 11.4% (5.8%) had intermediate attribute importance scores (SDs). Cost 7.9% (4.4%) and stigma 3.1% (1.3%) had the lowest attribute importance scores (SDs) in patient decisions.
These findings suggest that multimodal pain control regimens that are associated with optimized pain relief and minimized risk of addiction are preferable to treat acute postoperative pain. The results suggest that identifying procedures for which patients prioritize minimizing risk of addiction over pain relief and incorporating patient preferences into decision-making may be associated with decreased postoperative opioid prescribing.
尽管存在滥用的潜在风险，手术后仍经常开出阿片类药物。虽然存在各种疼痛控制方案，但患者对急性术后疼痛管理的偏好尚不清楚。
描述患者报告的术后疼痛管理的关键属性。
设计、设置和参与者：本决策分析模型使用基于联合分析的调查回复来研究患者对术后疼痛管理不同方面的重视程度。参与者为 2018 年 7 月 1 日至 2019 年 7 月 23 日期间在单一学术中心接受择期手部手术的 18 岁或以上患者。该调查于 2019 年 11 月至 2020 年 1 月期间在网络平台上进行。数据分析于 2021 年 5 月至 7 月进行。
参与者被呈现一系列离散选择任务，并被要求在 2 种术后药物选择之间进行选择，这些药物选择在问题之间发生变化，具有不同的特征。
计算疼痛控制查询方面的属性重要性评分和部分价值效用值。
在受邀的 710 人中，有 321 人（45.2%）完成了调查；其中 212 人（66.0%）为女性，108 人（33.6%）为男性，最常见的年龄组为 60 至 69 岁（102 人[31.8%]）。大多数患者报告有先前的阿片类药物使用史（282 人[87.9%]）。决策过程中具有最高属性重要性评分（SD）的因素是成瘾风险（26.3%[13.0%]）和疼痛缓解程度（25.6%[14.6%]）。不良影响 13.9%（7.2%）、功能独立性 11.8%（7.3%）和对处方者的信任度 11.4%（5.8%）具有中等属性重要性评分（SD）。成本 7.9%（4.4%）和耻辱感 3.1%（1.3%）在患者决策中具有最低的属性重要性评分（SD）。
这些发现表明，与优化疼痛缓解和最小化成瘾风险相关的多模式疼痛控制方案更适合治疗急性术后疼痛。结果表明，确定患者优先考虑降低成瘾风险而不是缓解疼痛的程序，并将患者的偏好纳入决策，可能与术后阿片类药物处方的减少有关。
