Patient experience of discharge opioid analgesia and care provision following spine surgery: A mixed methods study.

Abstract

Background: Perioperative opioid stewardship programs are increasingly being introduced to guide responsible use around the time of surgery to reduce opioid-related harm to patients. However, patient experiences of perioperative opioid stewardship programs are underexplored.

Methods: We designed a mixed methods study to explore patients' experiences of perioperative opioid stewardship in the post-operative period following spine surgery. We performed evaluative action research, combining quality improvement and ethnographic methodologies. Our quantitative methods were retrospective medical record review and targeted survey research. Our qualitative methods were online focus groups. The quantitative data were analysed using descriptive statistics, chi-square, and rank sum testing. The focus group data underwent inductive thematic analysis.

Results: Our spine surgery cohort for the four-month study period included 101 patients. The median total discharge opioid dispensed was 75 mg [interquartile range 75-150 mg], with 30% of patients prescribed modified release opioids on discharge. A subset of patients (N = 14) participated in the online focus groups. The key themes that emerged from these sessions were (1) Supportive care delivery and rescue mechanisms were universally important to patient participants, providing great reassurance during their recovery; (2) Participants commonly believed opioid analgesia had an important role in recovery following spine surgery. Some patients were keen to dispose of surplus opioids whilst others intended to retain them; (3) Opioid analgesia access was variable, but established community prescriber relationships were important for post-discharge opioid re-prescription, and (4) The key future improvement suggestions included routine post-discharge contact and enhanced communication options back to the hospital if needed.

Discussion and conclusions: Our mixed methods approach provided rich insights into the pain and opioid analgesia experiences of patients following spine surgery. These insights are useful when seeking to optimise perioperative opioid stewardship programs including better meeting the needs of patient consumers. Limitations included potential response and selection bias for the online focus groups towards younger, higher socioeconomic status patients.