Interesting study, on readmission to hospital within one day of discharge from a general surgical service, in Australia. And the most common reason for readmission?
Could it be that all those anti-opioid zealots who are ‘minimising’ opioids use, which in reality often means denying opioid pain relief, might have to admit that denying opioids for post-surgical pain is A Bad Idea?
The study states: “Analysis of index admissions showed that 18/35 (51%) readmissions for pain had inadequate pain management based on pain scores, analgesic use and discharge medications”
Meaning just over half of those readmitted on the same day they were discharged did not have a proper pain management plan in place, had not received proper pain relief in the hospital and were not provided with pain medications to take home. So, basically had their pain ignored. They were probably told to take a Panadol, because its just as effective as opioids, right?
I have seen study after study in the US gloating about ‘opioid free’ surgery. And all I can say is “WTF?” Because while the US definitely has an opioid epidemic, it was not caused by overprescribing for pain, chronic, acute or post operative.
I would love to talk to the patients in these studies. I would bet the farm that many (or most…all?) of them had under or unmanaged pain. And likely experienced distress and possibly even trauma due to lack of pain management after their ‘opioid free’ surgery. This distress and trauma is completely unnecessary, because anyone who reads the actual science knows that addiction from post operative opioid use is vanishingly rare. As is addiction as a result of long-term opioid therapy for chronic non-cancer pain. Prescription opioids are very rarely the cause of addiction and/or overdose. FULL STOP. By why let the truth get in the way of a good political campaign?
Isn’t it time that the trope of the ‘accidental addict’ was put to bed? Oh, but the media loves it so much. So much clickbait!
Isn’t it time we stopped torturing people unnecessarily?
How have doctors, people who have devoted a huge part of their lives at great personal sacrifice to heal and help people, how have doctors been brainwashed into believing that prescription opioids caused the US opioid epidemic? Especially in Australia, where there IS NO opioid epidemic!
Just this morning I was reading another study by Monash university which states “Previous Monash University research has found three million Australian adults take opioid pain medications each year”. I’ve seen that number quoted many times before. Three million sounds like a lot of opioids. And it is. A LOT.
So how many people die with an opioid in their system? And remember, that’s with an opioid in their system, not necessarily from an opioid overdose. The overwhelming cause of death, where opioids are involved, is polypharmacy. And the number of opioid related deaths in 2019 ? Was 460. That’s a mortality rate of about 0.01%.
No death is good, but seriously, does that sound like an opioid crisis to you? Does that sound like a good reason to deny people, who have just endured a painful surgery, proper pain relief? And discharge them without a pain management plan?
Apparently their suffering does not matter. What matters is fear of a mythical opioid epidemic. But now, finally, change is going to come, because this study has pointed out the thing that the health system cares about most:
The costs involved with readmission are huge, both to the healthcare system and the patient.
Most importantly, the health system. When politicians and administrators realise that denying patients proper pain management with opioids is costing them money (a lot of it) then, and only then, will the anti-opioid policies change.
It’s sad that alleviating the suffering of patients does not seem to be seen as important as saving money for the health system. As always, money is the biggest motivator.
But to be frank, as long as patients receive appropriate pain management for their post-surgical pain, I’m not going to argue about the motivation. Whatever gets pain proper pain management done.
But I also believe it’s very important to acknowledge that these readmissions are painful, distressing, and likely lead to distrust in the healthcare system for many patients. Additionally, untreated acute pain has been shown to lead to chronic pain, which is only second to death in terms of adverse outcomes.
How do we prevent this? Treat pain appropriately!
From the authors:
“There may be thus two-fold economic benefit in treating acute postoperative pain: first, in reducing costs from reduced recovery time, length of stay and readmissions; and second, in reducing the economic burden related to the treatment of chronic pain.”
Just kidding. I believe this is a laudable study and I hope that it gets wide media coverage, to draw attention to both the lack of proper pain management happening in Australian hospitals, and the very obvious solution – treat pain appropriately.
Do not try to fix a problem that does not exist (Australian Opioid Epidemic) by creating a problem that is far worse – an epidemic of untreated and undertreated pain in post operative care.
An epidemic of untreated CHRONIC pain ALREADY exists in Australia. Let’s not make it worse by adding thousands more to their number due to negligent post-surgical care.
As the study concludes,
“Pain is the most common reason for readmission within the first day after discharge in surgical patients. Better pain management…could prevent many readmissions.”
Study link: Readmission Within the First Day of Discharge Is Painful: Experience From an Australian General Surgical Service
Study Published: 5 December 2022
The CDC guidelines have caused only harm – no good. Once a patient leaves that hospital it’s Out of sight & out of mind. Don’t our lives matter ?