Surgeon Perceptions of the Management of Patients with Opioid Use Disorder

Abstract

Introduction: Patients with opioid use disorder (OUD) are increasing, challenging surgeons to adjust postoperative pain management guidelines. A literature review identified limited information on how to best care for these patients. The purpose of this study was to determine perioperative management of OUD, challenges, and support needed for optimal care. Methods: Triangulation methodology was implemented to gain quantitative and qualitative feedback. The IRB exempt survey requested no identifiable data and demographic data included only years in practice and specialty. The request for survey participation was posted 3 consecutive weeks in the American College of Surgeons Bulletin Brief. Descriptive statistics and open-ended questions addressed challenges, barriers, harm reduction, and support. Common themes were identified for each area. Results: A total of 264 surgeons responded representing all specialties except ophthalmic. General surgery (64%) and plastic and reconstructive (10%) represented most responders with the other specialties at 3% of participants. Ninety-seven percent reported encountering a patient with OUD in the past month. Almost half (44%) reported being uncomfortable managing postoperative pain. Most (70%) were not aware of any guidelines or standards pertaining to perioperative management of patients with OUD. While consultation was sought by 86% of surgeons the themes identified lack of timely response and a lack of care coordination among specialists. Lack of knowledge and fear of harm (contributing further to addiction) were the most common themes. Conclusion: Surgeons report discomfort and lacking knowledge with managing patients with OUD. Education and guidelines are desired along with better care coordination among specialists.