Karishma Rohanraj Desai,
Postdoctoral Scholar,
Stanford Center for Biomedical Informatics Research,
Stanford University

ABSTRACT:
Pain management is a major challenge for surgical patients and many are left with poorly managed pain control. In addition, concomitant use of other medications such as other analgesics (acetaminophen, non-steroidal anti-inflammatory drugs), anti-depressants, anesthetics, could interact with opioid medications and lead to different pain outcomes due to their synergistic or antagonistic effects. Leveraging the power of computational resources for processing the vast amount of medical information residing in EHRs, we aimed to characterize the prevalence of different combinations as supported by literature and further examine its effect on key postoperative outcomes in two health systems, Stanford Hospital and Veterans Health Administration. We identified patients receiving pain-intensive surgeries using ICD-9/10 codes, defined the fields within EHR and extracted medications and pain scores from EHRs. Pain scores followed the standard scale 0-10, with 10 being extreme pain. Using these data, we developed descriptive statistics to illustrate the prevalence of combined use of opioids with ;1) other pain medications at discharge(acetaminophen, non-steroidal anti-inflammatory drugs), 2) anti-depressants- selective-serotonin reuptake inhibitors (SSRIs) and 3) gabapentinoids (gabapentin/pregabalin) . Further, multivariate regression models were used to examine the effect of each combination on post-operative pain at discharge, first follow-up and readmissions. Models controlled for patient and clinical characteristics (e.g. gender, age, race/ethnicity, insurance type, severity -Charlson Comorbidity Index, type of surgery, average inpatient morphine equivalents, preoperative pain, days to follow-up).