An analysis of the impact of a multimodal therapy order set on postoperative opioid prescribing after orthopedic shoulder procedures

Abstract

Background

Opioids are effective for postoperative pain control but are no longer considered appropriate as the sole method for managing pain after surgery. Newer, multimodal approaches to pain control are increasingly being employed to decrease reliance on opioids, but patient-related outcomes are not consistently reported with these interventions.

Objective

This study evaluated the effect of implementing a new multimodal therapy order set, coupled with new patient education materials, on postoperative outcomes after complex shoulder surgery.

Methods

This retrospective cohort study compared outcomes from patients who received medications via the new multimodal therapy order set (order set cohort) and patients who did not (nonorder set cohort). All patients were contacted on postoperative days 1,7, and 14 to answer questions about postoperative pain and general measures of function. Data on opioid prescribing and use were collected. There were 2 primary endpoints: median morphine equivalent daily dose (MEDD) prescribed at 14 days postsurgery and median satisfaction with pain control at 14 days postsurgery.

Results

There were 16 patients included in the nonorder set cohort and 19 in the order set cohort. At 14 days postsurgery, the median MEDD prescribed was significantly less in the order set cohort than in the nonorder set cohort (P = 0.003), and there was no significant difference in patient satisfaction scores between groups.

Conclusion

The implementation of a multimodal order set, coupled with new patient education materials, resulted in a significant reduction in the median MEDD of prescribed opioids without negatively influencing patient satisfaction after complex shoulder interventions.