Feasibility of a multidisciplinary Transitional Pain Service in spine surgery patients to minimise opioid use and improve perioperative outcomes: a quality improvement study
Introduction Spine surgery patients have high rates of perioperative opioid consumption, with a chronic opioid use prevalence of 20%. A proposed solution is the implementation of a Transitional Pain Service (TPS), which provides patient-tailored multidisciplinary care. Its feasibility has not been d...
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BMJ Publishing Group
2023-06-01
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| Series: | BMJ Open Quality |
| Online Access: | https://bmjopenquality.bmj.com/content/12/2/e002278.full |
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| author | Sarah Tierney Patricia Poulin Daniel McIsaac Marie-Claude Magnan Amin Zahrai Alexandra Stratton |
| author_facet | Sarah Tierney Patricia Poulin Daniel McIsaac Marie-Claude Magnan Amin Zahrai Alexandra Stratton |
| author_sort | Sarah Tierney |
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| description | Introduction Spine surgery patients have high rates of perioperative opioid consumption, with a chronic opioid use prevalence of 20%. A proposed solution is the implementation of a Transitional Pain Service (TPS), which provides patient-tailored multidisciplinary care. Its feasibility has not been demonstrated in spine surgery. The main objective of this study was to evaluate the feasibility of a TPS programme in patients undergoing spine surgery.Methods Patients were recruited between July 2020 and November 2021 at a single, tertiary care academic centre. Success of our study was defined as: (1) enrolment: ability to enrol ≥80% of eligible patients, (2) data collection: ability to collect data for ≥80% of participants, including effectiveness measures (oral morphine equivalent (OME) and Visual Analogue Scale (VAS)-perceived analgesic management and overall health) and programme resource requirements measures (appointment attendance, 60-day return to emergency and length of stay), and (3) efficacy: estimate potential programme effectiveness defined as ≥80% of patients weaned back to their intake OME requirements at programme discharge.Results Thirty out of 36 (83.3%) eligible patients were enrolled and 26 completed the TPS programme. The main programme outcomes and resource measures were successfully tracked for >80% of patients. All 26 patients had the same or lower OME at programme discharge than at intake (intake 38.75 mg vs discharge 12.50 mg; p<0.001). At TPS discharge, patients reported similar overall health VAS (pre 60.0 vs post 70.0; p=0.14), improved scores for VAS-perceived analgesic management (pre 47.6 vs post 75.6; p<0.001) and improved Brief Pain Inventory pain intensity (pre 39.1 vs post 25.0; p=0.02).Conclusion Our feasibility study successfully met or exceeded our three main objectives. Based on this success and the defined clinical need for a TPS programme, we plan to expand our TPS care model to include other surgical procedures at our centre. |
| format | Article |
| id | doaj-art-077a4310da704a64ab3fe966179d0b78 |
| institution | Kabale University |
| issn | 2399-6641 |
| language | English |
| publishDate | 2023-06-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Open Quality |
| spelling | doaj-art-077a4310da704a64ab3fe966179d0b782024-12-20T16:05:09ZengBMJ Publishing GroupBMJ Open Quality2399-66412023-06-0112210.1136/bmjoq-2023-002278Feasibility of a multidisciplinary Transitional Pain Service in spine surgery patients to minimise opioid use and improve perioperative outcomes: a quality improvement studySarah Tierney0Patricia Poulin1Daniel McIsaac2Marie-Claude Magnan3Amin Zahrai4Alexandra Stratton5Ottawa Hospital Research Institute, Ottawa, Ontario, CanadaClinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, CanadaDepartment of Anesthesia and Pain Medicine, University of Ottawa, Ottawa, Ontario, CanadaDepartment of Orthopedics, Spine Division, Ottawa Hospital, Ottawa, Ontario, CanadaDepartment of Clinical Psychology, Ottawa Hospital, Ottawa, Ontario, CanadaOttawa Hospital Research Institute, Ottawa, Ontario, CanadaIntroduction Spine surgery patients have high rates of perioperative opioid consumption, with a chronic opioid use prevalence of 20%. A proposed solution is the implementation of a Transitional Pain Service (TPS), which provides patient-tailored multidisciplinary care. Its feasibility has not been demonstrated in spine surgery. The main objective of this study was to evaluate the feasibility of a TPS programme in patients undergoing spine surgery.Methods Patients were recruited between July 2020 and November 2021 at a single, tertiary care academic centre. Success of our study was defined as: (1) enrolment: ability to enrol ≥80% of eligible patients, (2) data collection: ability to collect data for ≥80% of participants, including effectiveness measures (oral morphine equivalent (OME) and Visual Analogue Scale (VAS)-perceived analgesic management and overall health) and programme resource requirements measures (appointment attendance, 60-day return to emergency and length of stay), and (3) efficacy: estimate potential programme effectiveness defined as ≥80% of patients weaned back to their intake OME requirements at programme discharge.Results Thirty out of 36 (83.3%) eligible patients were enrolled and 26 completed the TPS programme. The main programme outcomes and resource measures were successfully tracked for >80% of patients. All 26 patients had the same or lower OME at programme discharge than at intake (intake 38.75 mg vs discharge 12.50 mg; p<0.001). At TPS discharge, patients reported similar overall health VAS (pre 60.0 vs post 70.0; p=0.14), improved scores for VAS-perceived analgesic management (pre 47.6 vs post 75.6; p<0.001) and improved Brief Pain Inventory pain intensity (pre 39.1 vs post 25.0; p=0.02).Conclusion Our feasibility study successfully met or exceeded our three main objectives. Based on this success and the defined clinical need for a TPS programme, we plan to expand our TPS care model to include other surgical procedures at our centre.https://bmjopenquality.bmj.com/content/12/2/e002278.full |
| spellingShingle | Sarah Tierney Patricia Poulin Daniel McIsaac Marie-Claude Magnan Amin Zahrai Alexandra Stratton Feasibility of a multidisciplinary Transitional Pain Service in spine surgery patients to minimise opioid use and improve perioperative outcomes: a quality improvement study BMJ Open Quality |
| title | Feasibility of a multidisciplinary Transitional Pain Service in spine surgery patients to minimise opioid use and improve perioperative outcomes: a quality improvement study |
| title_full | Feasibility of a multidisciplinary Transitional Pain Service in spine surgery patients to minimise opioid use and improve perioperative outcomes: a quality improvement study |
| title_fullStr | Feasibility of a multidisciplinary Transitional Pain Service in spine surgery patients to minimise opioid use and improve perioperative outcomes: a quality improvement study |
| title_full_unstemmed | Feasibility of a multidisciplinary Transitional Pain Service in spine surgery patients to minimise opioid use and improve perioperative outcomes: a quality improvement study |
| title_short | Feasibility of a multidisciplinary Transitional Pain Service in spine surgery patients to minimise opioid use and improve perioperative outcomes: a quality improvement study |
| title_sort | feasibility of a multidisciplinary transitional pain service in spine surgery patients to minimise opioid use and improve perioperative outcomes a quality improvement study |
| url | https://bmjopenquality.bmj.com/content/12/2/e002278.full |
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