An Analysis of the Impact of a Multimodal Therapy Order Set on Post-Operative Opioid Prescribing After Orthopedic Shoulder Procedures.

Background: Opioids are effective for post-operative pain control but are no longer considered appropriate as the sole method for managing pain after surgery. Newer, multimodal approaches to pain control are increasingly being employed to decrease reliance on opioids, but patient-related outcomes are not consistently reported with these interventions.

Objective: This study evaluated the effect of implementing a new multimodal therapy order set, coupled with new patient education materials, on post-operative outcomes after complex shoulder surgery.

Methods: This retrospective cohort study compared outcomes from patients who received medications via the new multimodal therapy order set (order set cohort) and patients who did not (non-order set cohort). All patients were contacted on post-operative days 1,7, and 14 to answer questions about post-operative pain and general measures of function. Data on opioid prescribing and use were collected. There were two primary endpoints: median morphine equivalent daily dose (MEDD) prescribed at 14 days post-surgery and median satisfaction with pain control at 14 days post-surgery.

Results: There were 16 patients included in the non-order set cohort and 19 in the order set cohort. At 14 days post-surgery, the median MEDD prescribed was significantly less in the order set cohort than in the non-order set cohort (p=0.003), and there was no significant difference in patient satisfaction scores between groups.

Conclusion: The implementation of a multimodal order set, coupled with new patient education materials, resulted in a significant reduction in the median MEDD of prescribed opioids without negatively influencing patient satisfaction after complex shoulder interventions.