Association of Decreased Postsurgical Opioid Prescribing With Patients’ Satisfaction With Surgeons

Abstract

IMPORTANCE Opioid overdose is the leading cause of injury-related death in the United States. Several studies have shown that surgeons overprescribe opioids, and guidelines for appropriate opioid prescribing are available. Concern about patient-reported satisfaction scores may be a barrier to surgeons adopting guideline-directed prescribing.OBJECTIVE To determine whether decreased opioid prescribing is associated with a decrease in patient-reported satisfaction with their surgeon. DESIGN, SETTING, AND PARTICIPANTS Retrospective analysis of clinician satisfaction scores at Dartmouth-Hitchcock Medical Center obtained in 2 periods: 1 before (period A) and 1 after (period B) an educational intervention that resulted in decreased opioid prescribing. The analysis included 11 surgeons who performed 5 common outpatient general surgical operations on 996 patients. Data were analyzed between March and August 2018. MAIN OUTCOMES AND MEASURESPatient-reported overall satisfaction rating of the surgeon (scale, 0-10). This was collected by a nonstudy-related, routine general institutional survey of approximately 40% of all outpatient encounters. RESULTSOf the total number of patients, 67% were women (667 of 996), and the mean patient age was 58 years. Comparing period A with B, the proportion of patients prescribed opioids decreased from 90.2% (n = 367 of 407) to 72.8% (n = 429 of 589) (P < .001). The mean number of opioid pills per prescription decreased from 28.3 to 13.3 (P < .001) and significantly decreased for each of the 11 surgeons. One hundred five of 996 patients (10.5%) undergoing index operations responded to the survey. There was no difference in the mean clinician satisfaction ratings from period A vs B (9.70 vs 9.65; P = .69). During the study periods, 640 total surveys were collected referencing these surgeons (including outpatient encounters associated with operations other than the 5 index cases). There was no difference in the mean satisfaction ratings from period A vs period B (9.55 vs 9.59; P = .62). When individual clinicians were analyzed, none had a significant difference in overall satisfaction rating from period A vs period B.CONCLUSIONS AND RELEVANCE Despite a marked decrease in the proportion of patients receiving opioids and in the number of pills prescribed, there was no significant change in clinician satisfaction ratings.

Institutional Reductions in Opioid Prescribing Following Hip Arthroscopy Do Not Change Patient Satisfaction Scores

“…Previous research has suggested that one obstacle to the widespread implementation of decreased opioidprescribing protocols is concern that narcotic reduction may lead to lower patient satisfaction scores. 13 These satisfaction metrics are important for health care center valuations but also have the ability to influence the care-providing, itself. Merriman et al 3 recently published the results of a survey sent to emergency medicine physicians and reported that 50% of physicians believe patients are more satisfied when given opioid medications in the emergency department or as a discharge prescription.…”

Feasibility of Implementing Opioid Stewardship Recommendations for Sinonasal Surgery

“…Their study revealed no statistically significant difference in patient satisfaction scores after decreasing the number of postoperative opioid pills prescribed by more than half following mastectomy, inguinal hernia repair, or cholecystectomy. 11…”

Receipt of opioids and patient care experiences among nonsurgical hospitalized adults

“…Despite these policy changes, the assumption that receipt of opioids during hospitalization improves patient care experiences has not been thoroughly tested. First, studies focusing on surgical inpatients reported inconsistent findings between receipt of opioids and patient experiences of care 15‐19 . For instance, some of the studies found that higher HCAHPS scores (ie, better patient experiences) were associated with less, not more, opioid use 18,19 .…”

“…For instance, some of the studies found that higher HCAHPS scores (ie, better patient experiences) were associated with less, not more, opioid use 18,19 . Other studies reported a lack of association between receipt of opioids and surgical patients’ experiences with care 15,17,20 . Second, prior studies focused on surgical inpatients failed to account for potential bias resulting from confounding by indication, which is the possibility that individuals receiving opioids differ meaningfully from patients who do not.…”