From the University of Wisconsin School of Medicine and Public Health (Rozenfeld, and Uppal), the University of Wisconsin-Madison School of Pharmacy (Hesselbach), the University of Wisconsin Hospitals and Clinics, Pharmacy (Ludwig), the Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health (Hetzel), and the Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health (Bice, and Williams).
J Am Acad Orthop Surg. 2022 Sep 1;30(17):e1122-e1136. doi: 10.5435/JAAOS-D-21-01237. Epub 2022 Apr 22.
The Pain Plan was developed collaboratively and implemented a unique systematic approach to reduce opioid usage in elective spine surgery.
This was a retrospective cohort study comparing patients who underwent elective spine surgery before and after Pain Plan implementation. The Pain Plan was implemented on May 1, 2019. The experimental group comprised patients over the subsequent 1-year period with a Pain Plan (n = 319), and the control group comprised patients from the previous year without a Pain Plan (n = 385). Outcome variables include hospital length of stay (LOS), inpatient opioid use, outpatient opioid prescription quantities, number of clinic communication encounters, and communication encounter complexity. Patients were prospectively divided into three surgical invasiveness index subgroups representing small-magnitude, medium-magnitude, and large-magnitude spine surgeries.
There was a statistically significant decrease in hospital LOS ( P = 0.028), inpatient opioid use ( P = 0.001), and the average number of steps per communication encounter ( P = 0.010) for Pain Plan patients and a trend toward decreased outpatient opioid prescription quantities ( P = 0.052). No difference was observed in patient-reported pain scores. Statistically significant decreases in inpatient opioid use were seen in large-magnitude (50% reduction, P < 0.001) and medium-magnitude surgeries (49% reduction, P < 0.001). For small-magnitude surgeries, there was no difference (1.7% reduction, P = 0.99). The median LOS for large-magnitude surgeries decreased by 38% (20.5-hour decrease, P < 0.001) and decreased by 34% for medium-magnitude surgeries (17-hour difference, P = 0.055). For small-magnitude surgeries, there was no significant difference ( P = 0.734). Outpatient opioid prescription quantities were markedly decreased in small-magnitude surgeries only. The total number of communication encounters was not statistically significant in any group. However, the number of steps within a communication encounter was significantly decreased ( P = 0.010), and staff survey respondents reported more efficient and effective postoperative pain management for Pain Plan patients.
Pain Plan implementation markedly decreased hospital LOS, inpatient opioid use and outpatient opioid prescription quantities, and clinic resource utilization in elective spine surgery patients.
疼痛计划是由多部门协作制定的，旨在通过一种独特的系统方法来减少择期脊柱手术中的阿片类药物使用。
这是一项回顾性队列研究，比较了疼痛计划实施前后接受择期脊柱手术的患者。疼痛计划于 2019 年 5 月 1 日实施。实验组为随后的 1 年内接受疼痛计划的 319 例患者（n = 319），对照组为前一年未接受疼痛计划的 385 例患者（n = 385）。结果变量包括住院时间（LOS）、住院内阿片类药物使用、门诊阿片类药物处方数量、就诊沟通次数和沟通复杂性。患者前瞻性地分为小、中、大手术三个手术侵袭性指数亚组。
疼痛计划组的 LOS（P = 0.028）、住院内阿片类药物使用（P = 0.001）和每次沟通的平均步骤数（P = 0.010）显著减少，门诊阿片类药物处方数量呈下降趋势（P = 0.052）。疼痛计划组患者的疼痛评分无差异。大、中手术的住院内阿片类药物使用量显著减少（大手术减少 50%，P < 0.001；中手术减少 49%，P < 0.001）。小手术则无差异（减少 1.7%，P = 0.99）。大手术的 LOS 中位数减少 38%（减少 20.5 小时，P < 0.001），中手术减少 34%（减少 17 小时，P = 0.055）。小手术则无显著差异（P = 0.734）。只有小手术的门诊阿片类药物处方数量显著减少。任何组的就诊沟通次数均无统计学意义。然而，沟通次数内的步骤数显著减少（P = 0.010），工作人员调查受访者报告疼痛计划患者的术后疼痛管理更有效。
疼痛计划的实施显著减少了择期脊柱手术患者的住院时间、住院内阿片类药物使用和门诊阿片类药物处方数量以及就诊资源的使用。
