Surgery · 2026
Surgery is not the end of the story: Challenges and strategies in the postoperative care of patients receiving long-term opioid therapy.
СтатьяНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
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Stathakios James, Tsai Rebecca Nika, Marzoughi Maedeh, Gardner Melissa, Szczygiel Lauren A, Lagisetty Pooja, Waljee Jennifer, Bicket Mark C
Аннотация
BACKGROUND: Patients taking prescription opioids before surgery experience worse postoperative outcomes, including complications, readmissions, and difficult pain control. Despite this, clinician attitudes and experiences related to the management of patients on long-term opioid therapy after surgery are currently underdescribed. We aimed to characterize current clinical challenges in the postoperative care of patients on long-term opioid therapy and identify strategies to optimize postoperative pain management from the clinician perspective.
METHODS: We conducted semistructured interviews with 61 clinicians. Participants were recruited from surgery, anesthesia, pain medicine, and primary care specialties through statewide surgical quality improvement networks and snowball sampling. Interviews sampled perspectives across diverse clinician types (practicing physicians, residents, and advanced practice providers) and settings (academic/private, urban/rural). The codebook was iteratively refined, interview transcripts were coded, and themes were developed through an analytic process with regular team discussion and consensus.
RESULTS: Three clinical challenges were identified as opportunities to improve care: (1) misaligned patient-clinician perceptions surrounding recovery, which could be addressed by expectation setting and education with patients; (2) diagnostic uncertainty after surgery in the setting of altered pain perception, addressed by knowledge of the anticipated recovery trajectory and recognition of pain greater than expected; and (3) fragmented postoperative coordination between clinicians, addressed by multidisciplinary collaboration and delineation of prescribing responsibilities.
CONCLUSION: Patients on long-term opioid therapy before surgery often have complex postoperative pain needs that challenge conventional perioperative workflows. Care pathways that support proactive patient-centered expectation setting, promote patient education, and strengthen cross-disciplinary communication may improve coordination and safety of postoperative opioid management.
METHODS: We conducted semistructured interviews with 61 clinicians. Participants were recruited from surgery, anesthesia, pain medicine, and primary care specialties through statewide surgical quality improvement networks and snowball sampling. Interviews sampled perspectives across diverse clinician types (practicing physicians, residents, and advanced practice providers) and settings (academic/private, urban/rural). The codebook was iteratively refined, interview transcripts were coded, and themes were developed through an analytic process with regular team discussion and consensus.
RESULTS: Three clinical challenges were identified as opportunities to improve care: (1) misaligned patient-clinician perceptions surrounding recovery, which could be addressed by expectation setting and education with patients; (2) diagnostic uncertainty after surgery in the setting of altered pain perception, addressed by knowledge of the anticipated recovery trajectory and recognition of pain greater than expected; and (3) fragmented postoperative coordination between clinicians, addressed by multidisciplinary collaboration and delineation of prescribing responsibilities.
CONCLUSION: Patients on long-term opioid therapy before surgery often have complex postoperative pain needs that challenge conventional perioperative workflows. Care pathways that support proactive patient-centered expectation setting, promote patient education, and strengthen cross-disciplinary communication may improve coordination and safety of postoperative opioid management.