Implementation of a restrictive discharge opioid algorithm after minimally invasive gynecologic surgery: Impact on patient-reported outcomes and refill requests

ObjectiveTo compare discharge opioid refills, prescribed morphine equivalent dose and quantity, and longitudinal patient-reported outcomes before and after implementation of a tiered opioid prescribing algorithm among women undergoing open gynecologic surgery within an enhanced recovery after surgery program.MethodsWe compared opioid prescriptions, clinical outcomes, and patient-reported outcomes among 273 women. Post-discharge symptom burden was collected up to 42 days after discharge using the validated 27-item MD Anderson Symptom Inventory and analyzed using linear mixed effects models and Kaplan–Meier curves for symptom recovery.ResultsAmong 113 pre-implementation and 160 post-implementation patients there was no difference in opioid refills (9.7% vs 11.3%, p=0.84). The post-implementation cohort had a significant reduction in median morphine equivalent dose (112.5 mg vs 225 mg, p<0.01), with no difference in median hospital length of stay (3 days vs 3 days, p=1.0) or 30-day readmission rate (9.4% vs 7.1%, p=0.66). There was no difference in patient-reported pain between the pre- and post-implementation cohorts on the day of discharge (severity 4.93 vs 5.14, p=0.53) or in any patient-reported symptoms, interference measures, or composite scores by post-discharge day 7. The median recovery time for most symptoms was 7 days, except for pain (14 days), fatigue (18 days), and physical interference (21 days), with no differences between cohorts.ConclusionsAfter implementation of a tiered opioid prescribing algorithm, the quantity and dose of discharge opioids prescribed decreased with no change in post-operative refills and without negatively impacting patient-reported symptom burden or interference, which can be used to educate and reassure patients and providers.

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Preoperative patient activation is predictive of improvements in patient-reported outcomes following minimally invasive lumbar decompression

European Spine Journal ◽

10.1007/s00586-020-06512-6 ◽

2020 ◽

Vol 29 (9) ◽

pp. 2222-2230

Author(s):

Nathaniel W. Jenkins ◽

James M. Parrish ◽

Shruthi Mohan ◽

Cara E. Geoghegan ◽

Caroline N. Jadczak ◽

...

Keyword(s):

Minimally Invasive ◽

Patient Reported Outcomes ◽

Patient Activation ◽

Lumbar Decompression ◽

Patient Reported ◽

Preoperative Patient

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Ten-year patient-reported outcomes following total and minimally invasive unicompartmental knee arthroplasty: a propensity score-matched cohort analysis

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-016-4404-7 ◽

2016 ◽

Vol 26 (5) ◽

pp. 1455-1464 ◽

Cited By ~ 41

Author(s):

Edward Burn ◽

Maria T. Sanchez-Santos ◽

Hemant G. Pandit ◽

Thomas W. Hamilton ◽

Alexander D. Liddle ◽

...

Keyword(s):

Propensity Score ◽

Minimally Invasive ◽

Knee Arthroplasty ◽

Unicompartmental Knee Arthroplasty ◽

Patient Reported Outcomes ◽

Cohort Analysis ◽

Matched Cohort ◽

Unicompartmental Knee ◽

Patient Reported

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Electronic symptom monitoring with patient-reported outcomes in patients recovering from ambulatory minimally invasive gynecologic cancer surgery: A prospective pilot study

Gynecologic Oncology ◽

10.1016/j.ygyno.2019.04.384 ◽

2019 ◽

Vol 154 ◽

pp. 164

Author(s):

O. Zivanovic ◽

A.J. Vickers ◽

R.E. Baser ◽

K.G. Curran ◽

M.W. Veith ◽

...

Keyword(s):

Pilot Study ◽

Minimally Invasive ◽

Patient Reported Outcomes ◽

Gynecologic Cancer ◽

Cancer Surgery ◽

Symptom Monitoring ◽

Prospective Pilot Study ◽

Patient Reported

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Two Year Follow-Up of Patient Reported Outcomes Following Third Generation Minimally Invasive Chevron Akin Osteotomies (MICA) in Hallux Valgus Surgery

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00052 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0005

Author(s):

Thomas L. Lewis ◽

Robbie Ray ◽

David Gordon

Keyword(s):

Minimally Invasive ◽

Hallux Valgus ◽

Patient Reported Outcomes ◽

Statistical Significance ◽

Case Series ◽

Published Data ◽

Third Generation ◽

Specific Patient ◽

Patient Reported

Category: Bunion Introduction/Purpose: The aim of this study was to explore the 2 year results of third generation (using screw fixation) Minimally Invasive Chevron and Akin osteotomies (MICA) for hallux valgus correction. There is a paucity of published data regarding the outcomes of this relatively new technique. We present the largest series in the literature, using three separate validated patient-reported outcome measures (EQ-5DL, VAS Pain and Manchester Oxford Foot Questionnaire (MOXFQ), for this time point. Methods: A single surgeon case series of patients with hallux valgus underwent primary third generation minimally invasive chevron and akin osteotomies for hallux valgus correction. Between August 2015 and January 2018, 290 MICAs were performed in 203 patients that were eligible for 2 year follow up. Baseline and 2 year post-operative patient reported outcomes were collected for 164 feet in 130 patients (124 females; 6 males). Paired t-tests were used to determine the statistical significance of the difference between pre- and post-operative scores. Results: The mean age was 56.6 (range 29.5-81.0, standard deviation (s.d.) 10.9). At two year follow up, mean MOXFQ scores improved for each domain: Pain; baseline 40.6 (range 0-100, s.d. 22.8), reduced to 11.3 (range 0-75, s.d. 16.0, p<0.001); Walking; 36.0 (range 0-100, s.d. 25.9) reduced to 8.2 (range 0-75.0, s.d. 16.0, p<0.001); Social interaction; 46.7 (range 0-100, s.d. 24.3), reduced to 7.7 (range 0-75.0, s.d. 13.9, p<0.001). Mean VAS Pain score improved from 30.4 (range 0.0-90.0, s.d. 23.6) to 9.4 (range 0.00-70.0, s.d. 15.6, p<0.001). Mean EQ-5D index score improved from 0.750 (range 0.066-1.000, s.d. 0.148) to 0.892 (range 0.410-1.000, s.d. 0.135, p<0.001). Mean EQ-5D VAS score did not significantly improve from 81.9 (range 0-100, s.d. 17.1) to 83.0 (range 0-100, s.d. 18.0, p=0.559). Conclusion: This is the largest prospective case series of short-term patient reported outcomes using a validated assessment method for hallux valgus, following third generation MICA to date. These data show that this technique is effective at improving foot and ankle specific patient reported outcomes at 2 years. This cohort is being followed over the longer term.

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