Provider preferences for postoperative analgesia in obese and non-obese patients undergoing ambulatory surgery

Anthony H. Bui, David L. Feldman, Michael L. Brodman, Peter Shamamian, Ronald N. Kaleya, Meg A. Rosenblatt, Debra D'Angelo, Donna Somerville, Santosh Mudiraj, Patricia Kischak, I. Michael Leitman

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Few guidelines exist on safe prescription of postoperative analgesia to obese patients undergoing ambulatory surgery. This study examines the preferences of providers in the standard treatment of postoperative pain in the ambulatory setting. Methods: Providers from five academic medical centers within a single US city were surveyed from May-September 2015. They were asked to provide their preferred postoperative analgesic routine based upon the predicted severity of pain for obese and non-obese patients. McNemar's tests for paired observations were performed to compare prescribing preferences for obese vs. non-obese patients. Fisher's exact tests were performed to compare preferences based on experience: >15years vs. ≤15years in practice, and attending vs. resident physicians. Results: A total of 452 providers responded out of a possible 695. For mild pain, 119 (26.4%) respondents prefer an opioid for obese patients vs. 140 (31.1%) for non-obese (p=0.002); for moderate pain, 329 (72.7%) for obese patients vs. 348 (77.0%) for non-obese (p=0.011); for severe pain, 398 (88.1%) for obese patients vs. 423 (93.6%) for non-obese (p<0.001). Less experienced physicians are more likely to prefer an opioid for obese patients with moderate pain: 70 (62.0%) attending physicians with >15years in practice vs. 86 (74.5%) with ≤15years (p=0.047), and 177 (68.0%) attending physicians vs. 129 (83.0%) residents (p=0.002). Conclusions: While there is a trend to prescribe less opioid analgesics to obese patients undergoing ambulatory surgery, these medications may still be over-prescribed. Less experienced physicians reported prescribing opioids to obese patients more frequently than more experienced physicians.

Original languageEnglish (US)
Article number9
JournalJournal of Pharmaceutical Policy and Practice
Volume11
Issue number1
DOIs
StatePublished - May 17 2018

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Ambulatory Surgical Procedures
Analgesia
Opioid Analgesics
Physicians
Pain
Postoperative Pain
Prescriptions
Analgesics
Guidelines

ASJC Scopus subject areas

  • Health Policy
  • Pharmacology, Toxicology and Pharmaceutics(all)

Cite this

Provider preferences for postoperative analgesia in obese and non-obese patients undergoing ambulatory surgery. / Bui, Anthony H.; Feldman, David L.; Brodman, Michael L.; Shamamian, Peter; Kaleya, Ronald N.; Rosenblatt, Meg A.; D'Angelo, Debra; Somerville, Donna; Mudiraj, Santosh; Kischak, Patricia; Leitman, I. Michael.

In: Journal of Pharmaceutical Policy and Practice, Vol. 11, No. 1, 9, 17.05.2018.

Research output: Contribution to journalArticle

Bui, AH, Feldman, DL, Brodman, ML, Shamamian, P, Kaleya, RN, Rosenblatt, MA, D'Angelo, D, Somerville, D, Mudiraj, S, Kischak, P & Leitman, IM 2018, 'Provider preferences for postoperative analgesia in obese and non-obese patients undergoing ambulatory surgery', Journal of Pharmaceutical Policy and Practice, vol. 11, no. 1, 9. https://doi.org/10.1186/s40545-018-0138-x
Bui, Anthony H. ; Feldman, David L. ; Brodman, Michael L. ; Shamamian, Peter ; Kaleya, Ronald N. ; Rosenblatt, Meg A. ; D'Angelo, Debra ; Somerville, Donna ; Mudiraj, Santosh ; Kischak, Patricia ; Leitman, I. Michael. / Provider preferences for postoperative analgesia in obese and non-obese patients undergoing ambulatory surgery. In: Journal of Pharmaceutical Policy and Practice. 2018 ; Vol. 11, No. 1.
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abstract = "Background: Few guidelines exist on safe prescription of postoperative analgesia to obese patients undergoing ambulatory surgery. This study examines the preferences of providers in the standard treatment of postoperative pain in the ambulatory setting. Methods: Providers from five academic medical centers within a single US city were surveyed from May-September 2015. They were asked to provide their preferred postoperative analgesic routine based upon the predicted severity of pain for obese and non-obese patients. McNemar's tests for paired observations were performed to compare prescribing preferences for obese vs. non-obese patients. Fisher's exact tests were performed to compare preferences based on experience: >15years vs. ≤15years in practice, and attending vs. resident physicians. Results: A total of 452 providers responded out of a possible 695. For mild pain, 119 (26.4{\%}) respondents prefer an opioid for obese patients vs. 140 (31.1{\%}) for non-obese (p=0.002); for moderate pain, 329 (72.7{\%}) for obese patients vs. 348 (77.0{\%}) for non-obese (p=0.011); for severe pain, 398 (88.1{\%}) for obese patients vs. 423 (93.6{\%}) for non-obese (p<0.001). Less experienced physicians are more likely to prefer an opioid for obese patients with moderate pain: 70 (62.0{\%}) attending physicians with >15years in practice vs. 86 (74.5{\%}) with ≤15years (p=0.047), and 177 (68.0{\%}) attending physicians vs. 129 (83.0{\%}) residents (p=0.002). Conclusions: While there is a trend to prescribe less opioid analgesics to obese patients undergoing ambulatory surgery, these medications may still be over-prescribed. Less experienced physicians reported prescribing opioids to obese patients more frequently than more experienced physicians.",
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AU - Bui, Anthony H.

AU - Feldman, David L.

AU - Brodman, Michael L.

AU - Shamamian, Peter

AU - Kaleya, Ronald N.

AU - Rosenblatt, Meg A.

AU - D'Angelo, Debra

AU - Somerville, Donna

AU - Mudiraj, Santosh

AU - Kischak, Patricia

AU - Leitman, I. Michael

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AB - Background: Few guidelines exist on safe prescription of postoperative analgesia to obese patients undergoing ambulatory surgery. This study examines the preferences of providers in the standard treatment of postoperative pain in the ambulatory setting. Methods: Providers from five academic medical centers within a single US city were surveyed from May-September 2015. They were asked to provide their preferred postoperative analgesic routine based upon the predicted severity of pain for obese and non-obese patients. McNemar's tests for paired observations were performed to compare prescribing preferences for obese vs. non-obese patients. Fisher's exact tests were performed to compare preferences based on experience: >15years vs. ≤15years in practice, and attending vs. resident physicians. Results: A total of 452 providers responded out of a possible 695. For mild pain, 119 (26.4%) respondents prefer an opioid for obese patients vs. 140 (31.1%) for non-obese (p=0.002); for moderate pain, 329 (72.7%) for obese patients vs. 348 (77.0%) for non-obese (p=0.011); for severe pain, 398 (88.1%) for obese patients vs. 423 (93.6%) for non-obese (p<0.001). Less experienced physicians are more likely to prefer an opioid for obese patients with moderate pain: 70 (62.0%) attending physicians with >15years in practice vs. 86 (74.5%) with ≤15years (p=0.047), and 177 (68.0%) attending physicians vs. 129 (83.0%) residents (p=0.002). Conclusions: While there is a trend to prescribe less opioid analgesics to obese patients undergoing ambulatory surgery, these medications may still be over-prescribed. Less experienced physicians reported prescribing opioids to obese patients more frequently than more experienced physicians.

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