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Original Investigation
October 16, 2019

Association of Decreased Postsurgical Opioid Prescribing With Patients’ Satisfaction With Surgeons

Author Affiliations
  • 1Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
  • 2Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
JAMA Surg. 2019;154(11):1049-1054. doi:10.1001/jamasurg.2019.2875
Key Points

Question  Is decreased opioid prescribing by surgeons associated with lower patient-reported satisfaction ratings of their surgeon?

Findings  In this survey study, surgeons could greatly decrease the proportion of their patients receiving opioids and the number of pills prescribed with no significant change in their satisfaction ratings.

Meaning  Concern regarding clinician satisfaction scores should not be a barrier to appropriate opioid prescribing by surgeons.

Abstract

Importance  Opioid overdose is the leading cause of injury-related death in the United States. Several studies have shown that surgeons overprescribe opioids, and guidelines for appropriate opioid prescribing are available. Concern about patient-reported satisfaction scores may be a barrier to surgeons adopting guideline-directed prescribing.

Objective  To determine whether decreased opioid prescribing is associated with a decrease in patient-reported satisfaction with their surgeon.

Design, Setting, and Participants  Retrospective analysis of clinician satisfaction scores at Dartmouth-Hitchcock Medical Center obtained in 2 periods: 1 before (period A) and 1 after (period B) an educational intervention that resulted in decreased opioid prescribing. The analysis included 11 surgeons who performed 5 common outpatient general surgical operations on 996 patients. Data were analyzed between March and August 2018.

Main Outcomes and Measures  Patient-reported overall satisfaction rating of the surgeon (scale, 0-10). This was collected by a nonstudy-related, routine general institutional survey of approximately 40% of all outpatient encounters.

Results  Of the total number of patients, 67% were women (667 of 996), and the mean patient age was 58 years. Comparing period A with B, the proportion of patients prescribed opioids decreased from 90.2% (n = 367 of 407) to 72.8% (n = 429 of 589) (P < .001). The mean number of opioid pills per prescription decreased from 28.3 to 13.3 (P < .001) and significantly decreased for each of the 11 surgeons. One hundred five of 996 patients (10.5%) undergoing index operations responded to the survey. There was no difference in the mean clinician satisfaction ratings from period A vs B (9.70 vs 9.65; P = .69). During the study periods, 640 total surveys were collected referencing these surgeons (including outpatient encounters associated with operations other than the 5 index cases). There was no difference in the mean satisfaction ratings from period A vs period B (9.55 vs 9.59; P = .62). When individual clinicians were analyzed, none had a significant difference in overall satisfaction rating from period A vs period B.

Conclusions and Relevance  Despite a marked decrease in the proportion of patients receiving opioids and in the number of pills prescribed, there was no significant change in clinician satisfaction ratings.

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