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AS I SEE IT


Postsurgical Pain Management in ASCs Prevent opioid dependency, minimize readmissions and improve patient experience BY SCOTT A. SIGMAN, MD


Major advances in surgical techniques have enabled ASCs to perform a myr- iad of outpatient surgery procedures on millions of


Americans. Many challenges, however, still exist in adequately managing post- surgical pain while minimizing nega- tive outcomes in the ASC setting.


Inadequate Pain Management Might Impact ASC Patient Pathway Pain management is at the forefront of a patient’s overall experience at an ASC. Further, patients experiencing uncon- trolled pain during their recovery at an ASC could have serious implications for the ASC, patients and health plans.


Patient Flow and Length of Stay Uncontrolled postsurgical pain has been shown to be a common reason for delays in patient flow and extended length of stay in the ambulatory set- ting, often shifting the priority from a timely recovery to unanticipated time spent controlling severe postoperative pain. This shift has a negative effect on productivity, particularly in ASCs, as physicians and nurses need to focus more time on helping patients achieve prolonged pain relief (i.e., through the unfavorable use of opioid medications) instead of discharging them to recover comfortably in their own homes. A study published in PubMed in October 1997, “Postoperative Pain in Ambulatory Surgery,” examined the pattern of pain in 10,008 consecutive ASC patients and found that the dis- charge time was substantially longer in those who experienced severe post- surgical pain versus those who did not. The same study revealed a signifi-


cantly longer length of stay in the post- anesthesia care unit (PACU) among patients who experienced severe post- surgical pain versus those who did not.


Important Considerations for ASCs Surgical Volume, Throughput and Efficiency ASCs strive to keep surgical volume high, increase surgical throughput and improve efficiency of overall ambula- tory surgery processes, including patient flow. How can these all be adequately achieved and what factors influence their success? Post-surgical pain and recov- ery are among the biggest drivers to the effective operation of an ASC but finding the right pain management approach can often be challenging and pose bar- riers that can interfere with productiv- ity and potentially result in substantial clinical and cost burdens to patients.


Patient Experience


Promoting an ideal patient experi- ence and improving patient satisfac- tion are other important considerations for ASCs. As observed in the Consumer


10 ASC FOCUS FEBRUARY 2019 | ascfocus.org


Assessment of Healthcare Providers and Systems Outpatient and Ambula- tory Surgery Survey (OAS CAHPS), postsurgical pain and pain management can potentially have a negative impact on patient satisfaction. Using appro- priate, patient-centered pain manage- ment therapies while reducing the risk for adverse events is an important step in improving patients’ experiences and furthering their confidence in ASCs.


Minimizing Readmissions and Health Care Resource Utilization While patient satisfaction and effi- cient postsurgical processes are neces- sary goals for ASCs, avoiding hospi- tal readmissions and maintaining low health care resource utilization related to pain also are critical to establishing ASC use over inpatient care. In a study published in PubMed in November 2010, “Importance of Side Effects in Opioid Treatment; a Trade-Off Analy- sis with Patients and Physicians,” 90 of 1,306 outpatient rotator cuff repair sur- gery patients returned for emergency department or urgent care center visits,


The advice and opinions expressed in this column are those of the author and do not represent official Ambulatory Surgery Center Association policy or opinion.


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