CHICAGO: A new quality improvement project led by the American College of Surgeons (ACS) will evaluate the most effective ways to help patients safely manage pain after surgery and reduce the risk of opioid dependence.
While opioid prescribing has gone down in the past 5 years, two-thirds of drug overdose deaths are due to prescription or illicit opioids.1 For many patients requiring surgery, surgeons typically are the first healthcare professionals to prescribe medication and advise on pain management. How best to reduce opioid dependence and improve communication and educational plans between insurance providers, surgical professionals, and patients remains a vital challenge.
Directly educating patients about safe pain control
This project will be conducted in collaboration with Health Care Service CorporationSM, a Mutual Legal Reserve Company (HCSC), the American Academy of Orthopedic Surgeons, and the American Association of Neurological Surgeons. ACS has engaged in a collaborative relationship with HCSC to broaden the understanding of the impact of patient and provider education/outreach on reducing the number of new, persistent opioid users following targeted surgical procedures.
As part of the project, patients who are having non-emergency hip, knee, and shoulder replacement procedures, or certain forms of spine surgery, will receive comprehensive safe pain control educational materials developed by the ACS and partner organizations directly from their care team.
Overdose deaths involving opioids, including prescription opioids, have increased by more than eight times since 1999, according to the Centers for Disease Control and Prevention.2 To address the unique challenges of opioid misuse, the ACS has prioritized patient education, and the role surgeons can play in safe pain management.
This program will be one of the largest interventions specific to high-risk patients undergoing musculoskeletal surgeries. The educational materials are expected to reach up to 6,000 patients annually.
Increasing access to life-saving resources
In their surgery pre-approval letter, members insured under an HCSC policy will receive access to online content that they can view anytime. Additionally, select high-risk patients will be contacted by an HCSC case manager before surgery, who will use ACS resources on postoperative pain management along with other support services. HCSC is the largest customer-owned health insurer in the United States, serving more than 18 million members across Illinois, Montana, New Mexico, Oklahoma, and Texas.
Patient engagement will be measured by determining what percentage of patients, assessed by risk, access the Safe Pain Control Program materials provided as part of their pre-approval letter and following case manager contact for high-risk patients.
Any member of the public not served by HCSC can also access various safe pain control educational materials on the ACS website at no cost. Surgeons are also invited to view a one-hour webinar about the collaboration and obtain CME credit.
Opioid misuse and opioid alternatives
More than 70% of patients awaiting musculoskeletal surgery experience pain that interferes with daily functioning, including difficulty going up or down stairs, stiffness, swelling, pain in bed, and avoiding exercise.3 It is estimated that 10%-15% of these patients use opioids intermittently to help manage their pain.4,5 Preoperative opioid use increases the risk of complications following surgery, such as dislocation due to increased fall risk or increased emergency room visits,2 as well as the development of tolerance to or dependence on opioids.
Research has shown that the rate of opioid misuse is related to two main factors:
The length of time the patient used opioids
If refills were provided
Research suggests that providing patients with education and a list of all pain-relief options, including over-the-counter ibuprofen and acetaminophen in addition to opioids, can reduce opioid doses by 50%.
Newsroom, C. “US drug overdose deaths continue to rise: increase fueled by synthetic opioids.” Page last reviewed: March 29, 2018, https://www.cdc.gov/media/releases/2018/p0329-drug-overdose-deaths.html
“-” CDC, Last Reviewed: May 8, 2023, https://www.cdc.gov/opioids/data/index.html
Nguyen, Uyen-Sa DT, David C. Ayers, Wenjun Li, Leslie R. Harrold, and Patricia D. Franklin. “Preoperative pain and function: profiles of patients selected for total knee arthroplasty.” The Journal of arthroplasty31, no. 11 (2016): 2402-2407.
Ravi, Bheeshma, Daniel Pincus, Ruth Croxford, Timothy Leroux, J Michael Paterson, Gillian Hawker, and Donald A. Redelmeier. “Patterns of pre-operative opioid use affect the risk for complications after total joint replacement.” Scientific Reports11, no. 1 (2021): 22124.
Naylor, Justine M., Natalie Pavlovic, Melissa Farrugia, Shaniya Ogul, Danella Hackett, Anthony Wan, Sam Adie, et al. “Associations between pre-surgical daily opioid use and short-term outcomes following knee or hip arthroplasty: a prospective, exploratory cohort study.” BMC musculoskeletal disorders21, no. 1 (2020): 1-10.
Yajnik, Meghana, Jonay N. Hill, Oluwatobi O. Hunter, Steven K. Howard, T. Edward Kim, T. Kyle Harrison, and Edward R. Mariano. “Patient education and engagement in postoperative pain management decreases opioid use following knee replacement surgery.” Patient education and counseling102, no. 2 (2019): 383-387.