Single-center quality improvement initiative reports 90-day opioid outcomes for 39 Veterans after surgery

A retrospective, single-center quality improvement initiative at the Veterans Affairs Pittsburgh Healthcare System provided perioperative pain-management recommendations for 51 Veterans, 39 of whom underwent surgery. At 90 days after surgery, the report stated that 32 of the 39 surgical patients had returned to their preoperative opioid requirement, although two patients were lost to follow-up and one died during the follow-up period. The initiative had no comparison group and therefore cannot establish that the program caused the observed outcomes.

The program was designed as a collaboration between the preoperative assessment team and clinical pharmacy for patients considered to be at high risk of new opioid dependence or increased postoperative opioid requirements. A clinical pharmacist conducted a virtual chart review that focused on chronic pain, current medications, substance use disorder and psychiatric comorbidities. Care teams then received patient-specific plans for inpatient and postoperative multimodal pain management.

Researchers reviewed all Veterans who received a perioperative PharmD e-consult from the program’s inception in October 2023 through September 2024. This was a quality improvement initiative that met the SQUIRE criteria for reporting. Process measures included fidelity to the multimodal recommendations, while outcome measures covered pain prescriptions before and after surgery and surgical outcomes through 90 days.

The e-consult cohort was predominantly male: 46 of 51 patients, or 90.2%, were male. Median age was 65 years, with an interquartile range of 48 to 71 years, and the median Risk Analysis Index frailty score was 25, with an interquartile range of 17 to 37. Psychiatric conditions were documented in 48 patients, or 94.1%, and substance use disorder was present in 26 patients, or 51.0%.

Most of the cohort used opioids chronically before the e-consult: 39 patients, or 76.5%, met the report’s definition of chronic preoperative use, defined as use for 60 consecutive days or at least three prescriptions within the 90 days before surgery. The most frequent reasons for referral were chronic preoperative opioid use, reported for 39.2% of the 51 patients, and a history of substance use disorder, reported for 34%. Among patients with chronic opioid use, 64.1% had been prescribed opioids for chronic pain and 35.9% had been prescribed medication for opioid use disorder.

Of the 39 patients who underwent surgery, 22, or 56.4%, required an inpatient stay. Inpatient pain-management recommendations were partly followed 95.5% of the time and completely followed 4.5% of the time. Discharge pain-management recommendations were partly followed for 32 patients, or 82.1%, and fully followed for seven, or 17.9%. Eighteen patients, representing 46.2% of the surgical cohort, were discharged with the pharmacist-recommended opioid plan.

The report stated that 32 of 39 surgical patients had reverted to their preoperative opioid requirement by 90 days. That group included eight of the nine patients who had not taken opioids preoperatively. Three patients required a higher chronic opioid dose, and one patient who had received medication for opioid use disorder remotely in the past year resumed it after surgery. The report also identified two patients lost to follow-up and one mortality, so complete 90-day information was not available for every member of the surgical cohort.

Fidelity to the multimodal recommendations varied. The authors noted that postoperative conditions, including limited enteral intake, may have contributed to this variability, but the report did not establish that those constraints definitively prevented full implementation. The surgical cohort also included a moderate number of patients receiving medication for opioid use disorder, a group the authors said had favorable postoperative outcomes.

Because the initiative was conducted at one institution, included a small surgical cohort and lacked a comparison group, the findings describe care and outcomes in this setting rather than demonstrating an intervention effect. The authors said a larger study across multiple institutions would be required to better assess the program’s value.

Subject of Research: Evaluation of a clinical-pharmacy perioperative pain-management program and postoperative opioid outcomes in Veterans at elevated risk

Article Title: A Multidisciplinary Approach to Reduce Prolonged Postoperative Opioid Use in High-risk Patients

Article References: Furman, L., Donnelly, S., Bardawil, C., Muluk, V., & Dhupar, R. (2026). A Multidisciplinary Approach to Reduce Prolonged Postoperative Opioid Use in High-risk Patients. Journal of General Internal Medicine. https://doi.org/10.1007/s11606-026-10810-y

Image Credits: AI Generated

DOI: 10.1007/s11606-026-10810-y

Keywords: quality improvement, postoperative opioid use, perioperative pain management, Veterans, clinical pharmacy, opioid use disorder, chronic opioid therapy, retrospective chart review, multimodal analgesia, Multidisciplinary, Approach, Reduce