Randomized Trial on Expectations and Pain Control Advancement in Surgery: The REPAIR Study

Abstract

Importance: Following standardized preoperative education and adoption of shared decision making positively affects postoperative narcotic practices.

Objectives: The aim of this study was to assess the impact of patient-centered preoperative education and shared decision making on the quantities of postoperative narcotics prescribed and consumed after urogynecologic surgery.

Study design: Women undergoing urogynecologic surgery were randomized to "standard" (standard preoperative education, standard narcotic quantities at discharge) or "patient-centered" (patient-informed preoperative education, choice of narcotic quantities at discharge) groups. At discharge, the "standard" group received 30 (major surgery) or 12 (minor surgery) pills of 5-mg oxycodone. The "patient-centered" group chose 0 to 30 (major surgery) or 0 to 12 (minor surgery) pills. Outcomes included postoperative narcotics consumed and unused. Other outcomes included patient satisfaction/preparedness, return to activity, and pain interference. An intention-to-treat analysis was performed.

Results: The study enrolled 174 women; 154 were randomized and completed the major outcomes of interest (78 in the standard group, 76 in the patient-centered group). Narcotic consumption did not differ between groups (standard group: median of 3.5 pills, interquartile range [IQR] of [0, 8.25]; patient centered: median of 2, IQR of [0, 9.75]; P = 0.627). The patient-centered group had fewer narcotics prescribed ( P < 0.001) and unused ( P < 0.001), and chose a median of 20 pills (IQR [10, 30]) after a major surgical procedure and 12 pills (IQR [6, 12]) after a minor surgical procedure, with fewer unused narcotics (median difference, 9 pills; 95% confidence interval, 5-13; P < 0.001). There were no differences between groups' return to function, pain interference, and preparedness or satisfaction ( P > 0.05).

Conclusions: Patient-centered education did not decrease narcotic consumption. Shared decision making did decrease prescribed and unused narcotics. Shared decision making in narcotic prescribing is feasible and may improve postoperative prescribing practices.

Trial registration: ClinicalTrials.gov NCT03726476.

FIGURE 1.

Study flow chart for the Randomized Trial on Expectations and Pain Control Advancement in Surgery study. Pre-Op, preoperative; Post-Op, postoperative; Pt, patient.

FIGURE 2.

Quantity of unused opioid pills within 2 weeks postoperatively. Scatterplots show each data point, and black boxplots reflect the overall comparison of study arms. The standard and intervention groups are broken down into separate, colored boxplots, with blue representing major surgery and red representing minor surgery. The P values are shown with brackets pointing to the groups being compared.