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Original research
Opioid use among veterans undergoing major joint surgery managed by a multidisciplinary transitional pain service
  1. Michael J Buys1,2,
  2. Kimberlee Bayless2,
  3. Jennifer Romesser3,
  4. Zachary Anderson2,
  5. Shardool Patel2,
  6. Chong Zhang4,
  7. Angela P Presson4 and
  8. Benjamin Brooke5,6
  1. 1Department of Anesthesiology, University of Utah, Salt Lake City, Utah, USA
  2. 2Anesthesiology, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
  3. 3Psychology, VA Salt Lake City Health Care System Mental Health Services, Salt Lake City, Utah, USA
  4. 4Internal Medicine-Epidemiology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
  5. 5Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
  6. 6Surgery, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
  1. Correspondence to Dr Michael J Buys, Department of Anesthesiology, University of Utah, Park City, UT 84098, USA; michael.buys{at}hsc.utah.edu

Abstract

Background Chronic postsurgical pain and opioid use is a problem among patients undergoing many types of surgical procedures. A multidisciplinary approach to perioperative pain management known as a transitional pain service (TPS) may lower these risks.

Methods This retrospective cohort study was conducted at the Salt Lake City VA Medical Center to compare patients undergoing elective primary or revision total knee, hip, or shoulder replacement or rotator cuff repair in the year before (2017) and after (2018) implementation of a TPS. The primary outcome is the proportion of patients taking opioids 90 days after surgery. Secondary outcomes include new chronic opioid use (COU) after surgery as well as the proportion of previous chronic opioid users who stopped or decreased opioid use after surgery.

Results At 90 days after surgery, patients enrolled in TPS were significantly less likely to be taking opioids (13.4% TPS vs 27.3% pre-TPS; p=0.002). This relationship remained statistically significant in a multivariable logistic regression analysis, where the TPS group had 69% lower odds of postoperative COU compared with the preintervention group (OR: 0.31; 95% CI: 0.14 to 0.66; p=0.03). Opioid-naive patients enrolled in TPS were less likely to have new COU after surgery (0.7% TPS vs 8.4% pre-TPS; p=0.004). Further, patients enrolled in TPS with existing COU prior to surgery were more likely to reduce or completely stop opioid use after surgery (67.5% TPS vs 45.3% pre-TPS; p=0.037) as compared with pre-TPS.

Conclusions These data suggest that a TPS is an effective strategy for preventing new COU and reducing overall opioid use following orthopedic joint procedures in a Veterans Affairs hospital.

  • analgesics
  • opioid
  • opioid-related disorders
  • pain
  • postoperative
  • chronic pain
  • acute pain

https://doi.org/10.1136/rapm-2020-101797

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    Footnotes

    • Twitter @DrKimBaylessNP

    • Contributors MJB contributed to the conception, design, data collection, data analysis and interpretation, and manuscript preparation. KB contributed to the conception, design, data collection, data analysis and interpretation, and manuscript preparation. JR contributed to the conception, design, data collection, data analysis and interpretation, and manuscript preparation. ZA contributed to the conception, design, data collection, data analysis and interpretation, and manuscript preparation. SP contributed to the conception, design, data collection, data analysis and interpretation, and manuscript preparation. CZ contributed to the data analysis and interpretation, and manuscript preparation. APP contributed to the data analysis and interpretation, and manuscript preparation. BB contributed to the conception, design, data analysis and interpretation, and manuscript preparation.

    • Funding Funding for this study was received from the VA Whole Health Initiative, the VA Center of Innovation, the VA Office of Rural Health, and the National Institutes of Health Grant (UL1TR002538).

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval University of Utah and Salt Lake City VA Institutional Review Board IRB_00106087.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available upon reasonable request. The data that support the findings of this study are available from the corresponding author (MJB), upon reasonable request.