A Delphi-consensus of United States vascular surgeons on "OPioid prescripTION in VASCular surgery (OPTION-VASC)".

Abstract

Objective: The aim of this study was to report an expert-based Delphi consensus from United States physicians on good practice patterns for opioid prescriptions in the management of vascular surgery patients.

Methods: A modified three-round Delphi consensus was conducted between March and April 2024. Three senior vascular surgeons acting as facilitators generated statements regarding the topic. Questions were evaluated using a 4-point Likert scale with open comment fields, and a consensus recommendation was accepted only when grade A (>75% agree) and grade B (agree and somewhat agree >80%) endorsements were met. Statements that did not meet the above criteria were not included in the final report. The consistency of the answers from each round were also analyzed with the intraclass correlation coefficient, Cohen's kappa, and, in case of double resubmission, Fleiss kappa. Consistency was leveled according to Cohen's kappa: level I (0.81-1.0), level II (0.61-0.8), and level III (0.41-0.6).

Results: Thirty-four United States vascular surgeons completed the Delphi process. Voting was performed on 33 statements relating to postoperative opioid prescription (n = 15), medical management with opioids (n = 4), opioid prescribing habits (n = 12), and practice guidelines (n = 2). After three rounds, consensus was achieved in all statements. Of these, 16 were considered grade A consistency level I, six were considered grade A consistency level II, nine were considered grade B consistency level II, and two were considered grade B consistency level III.

Conclusions: Opioids serve a role in vascular surgery patient management in both operative and nonoperative scenarios. The statements included in this Delphi consensus may serve to guide future studies on opioid usage in these patients and help inform future guidelines in the management of opioid medications.