Pain Plan Implementation Effect: Analysis of Postoperative Opioid Use, Hospital Length of Stay, and Clinic Resource Utilization for Patients Undergoing Elective Spine Surgery

Abstract

Introduction:The Pain Plan was developed collaboratively and implemented a unique systematic approach to reduce opioid usage in elective spine surgery. Methods: 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. Results: 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 smallmagnitude 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

Utilizing previous patient opioid experiences for pain plan implementation: Role of opioid use categorization on inpatient and outpatient opioid use, length of stay, pain scores, and clinic resource utilization following elective spine surgery

“…In conclusion, Madison Pain Plan implementation, particularly the use of categories when developing the plan, has proven to be a valuable tool for postoperative pain management at our institution. Nurses, orthopedic surgery residents, fellows, attendings, and APPs actively engage in the Pain Plan process because they have noticed a substantial improvement in pain management encounters with patients when the Pain Plan is referenced [17] . We feel that the Pain Plan formulation process empowers patients to be involved in pain management decision-making and sets expectations and limits.…”

“…The details of Pain Plan formulation are described in detail by Rozenfeld et al. [17] . The outpatient surgery template differed from the inpatient templates only in the lack of a list of inpatient medications.…”

“…The Pain Plan is typically completed by the resident, fellow, or attending in the clinic when surgery is indicated. Pain Plan formulation takes on average 3 min for patients not on opioids preoperatively and 5 min for patients on opioids preoperatively [17] .…”