Postoperative Pain Management in Older Patients

Background: Postoperative pain management in the older population has been described as a complex topic with providers trying to balance pain control while minimizing adverse effects of decreased physiologic reserve such as delirium and decreased cognitive function. The goal of this study was to compare pain scores and pain medications prescribed at discharge between an older age group and a middle age group after an elective cholecystectomy. Methods: We conducted a retrospective study at a community hospital in western Massachusetts collecting data from March 1, 2022, to February 28, 2023 using laparoscopic cholecystectomy CPT code. Included were patients between 50 to 80 years old with same day discharge. Charts were reviewed to collect data on patient age, subjective pain score documented on the last nursing note, and prescribed pain medications. Opioid medications were converted to morphine milligram equivalents (MME). Statistical analysis was performed using a t-test with p. Results: Of the total 232 charts, 146 were excluded leaving 86 patients; Group 1 (middle age) having 51 patients, Group 2 (older age) 35 patients. Discharge pain scores ranged from 0 to 8 in the middle age group (mean 1.7), 0 to 7 in the older age group (mean 2.1). The MME’s ranged from 100 to 225 in the middle age group (mean 144.8) and 100 to 160 in the older age group (mean 134.9). Acetaminophen and NSAIDS were written on all discharge orders. There was no significant difference between mean pain scores (p = 0.30). The older group received significantly less opioids than the middle age group (p = 0.04). Discussion: Consensus on the amount of postoperative opioid medication prescriptions in relation to age has not been obtained. Older adults have been shown to be prescribed less opioid medications possibly due to contraindications and increased risk of adverse effects, consistent with our study that found less opioids were prescribed to the older age group compared to the middle age group with equivalent pain scores. Provider education on prescribing habits in relationship to age, pain, and opioid use could decrease this discrepancy while balancing concerns for adverse effects.