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IMPACT OF PRE-OPERATIVE COPING STRATEGIES ON POST-OPERATIVE OPIOID CONSUMPTION AND SATISFACTION
Sidhant Kalsotra
*, Divyaam Satija, William T. Head, Dylan S. Goto, Stefanie C. Rohde, Savannah Renshaw, Benjamin Poulose
General and Gastrointestinal Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
Introduction
Patients’ psychological coping mechanisms have been shown to influence post-surgical recovery trajectories and pain perception, yet the specific relationship between coping strategies and post-operative opioid usage remains inadequately understood in the current literature. We aim to investigate how different pre-operative coping strategies influence post-operative opioid consumption and patient satisfaction in patients undergoing elective general surgery procedures.
Methods
A single center prospective study of patients undergoing surgery at a quaternary referral center was conducted from 2021-2024. Current opioid users, immunocompromised patients, and those with NSAID/acetaminophen allergies were excluded. The Brief COPE (Coping Orientation to Problems Experienced) is a questionnaire that assesses a range of coping mechanisms that respondents employ when facing stressful situations. Primary outcome was post-operative opioid consumption, and secondary outcome was patient satisfaction. Logistic regression analyzed associations between Brief COPE subscale scores and opioid use, adjusting for age, sex, race, surgery type. Multiple linear regression evaluated relationships between Brief COPE scores and patient satisfaction (1-10 scale), adjusting for the same variables.
Results
Our study enrolled 223 patients with median age of 50 years (IQR 23.5, range 19-91); 69% were male and 91% white. The most common operation was inguinofemoral hernia repair (53%). Other procedures were epigastric, umbilical, or incisional hernia repairs (27%), laparoscopic cholecystectomy (17%), and small skin lesion excisions (2%). Unadjusted data showed no statistically significant differences in post-operative opioid rescue pill use between the two groups (OR = 1.71, p = 0.06). This was consistent even after adjusting for potential confounders, (Adjusted OR = 1.56, p = 0.17). Similarly, no significant differences were noted in post-operative satisfaction scores (Unadjusted ? = -0.41, p = 0.06). This was also consistent after adjustment, with an adjusted ? of -0.48 (p = 0.06). Conversely, post-operative pain intensity showed significant associations with adaptive coping strategies. In the unadjusted analysis, pain intensity was ? = 0.596 (p = 0.01), and after adjustment, remained significant with ? = 0.533 (p = 0.035). (Table 1).
Conclusions
Our study reveals nuanced insights into the relationship between pre-operative coping strategies and post-operative outcomes. Contrary to initial expectations, we found no statistically significant associations between most coping strategies and post-operative opioid use or patient satisfaction. Interestingly, patients exhibiting higher scores in adaptive coping strategies like active coping and positive reframing paradoxically reported increased pain intensity. This highlights the complex psychological dynamics of surgical recovery.
Multivariate Analysis of Coping Strategies as measured by the Brief COPE scale and Post-Operative OutcomesPatient-Reported Outcomes
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