W. Li1, T. N. Jackson1, N. A. Royall1 1The University of Oklahoma School of Community Medicine,Department Of Surgery,Tulsa, OK, USA
Introduction:
The United States is facing an opioid epidemic which has resulted in an increase of opioid use and consequently abuse and death. Surgical residents are often responsible for providing post-operative instructions and pain medications for patients after surgery in training programs. The purpose of this study is to evaluate and understand the beliefs and prescribing practices of General Surgery residents after outpatient laparoscopic cholecystectomy procedures.
Methods:
A cross-sectional survey was conducted from November 2018 to February 2019 of all General Surgery residents in ACGME-accredited training programs in Oklahoma. A web-based electronic questionnaire was developed to determine pain medication prescribing practices of residents for patients undergoing outpatient laparoscopic cholecystectomy. Perceptions were assessed on the role of pharmacologic opioid and non-opioid agents as well as non-pharmacologic interventions in pain control. Chi-squared and Fisher’s exact test were performed to analyze the results.
Results:
The survey was sent to 75 General Surgery categorical and preliminary residents in Oklahoma, with a 40% response rate (30/75). Respondents were predominantly male (63%) and categorical residents (90%). Frequency of prescriptions provided by all respondents were opioids (29/30 97%), non-steroidal anti-inflammatory drugs (28/30 93%), muscle relaxants (24/30 80%), gabapentinoids (21/30 70%), and benzodiazapines (6/30 20%). Junior residents (16/16 PGY1-2 residents; 100%) reported that a shorter duration of narcotic pain medication (less than 4 days vs 4 or more days) was required for pain relief following laparoscopic cholecystectomy compared to senior residents (6/13 PGY3-5 residents; 46%); (p=0.001). Preliminary residents (2/3 66%) were more likely to report opiate quantity as the most important factor in ensuring adequate pain control after laparoscopic cholecystectomy than categorical residents (2/26 8%); (p=0.040). Junior residents (12/16 75%) reported preoperative counseling as the most important factor to achieve post-operative pain relief, while senior residents (8/13 62%) reported post-operative interventions (prescriptions and follow-up) as the most important (p=0.015).
Conclusion:
There is a high-rate of pharmacologic opioid and non-opioid prescribing amongst surgical trainees in Oklahoma. Prescription practices and perceptions on pain management by General Surgery residents in Oklahoma demonstrate significant variability based on level of training. Development of educational programs on pharmacologic and non-pharmacologic pain management is needed to improve safe pain management in General Surgery trainees.
