Prolonged Use of Pain Medication Past the Postoperative Period in Older Adults

Project Summary/Abstract………………………………………………………………………………………………
This is an application for a K23 award for Dr. Tasce Bongiovanni, an acute care, trauma and surgical critical
care physician at University of California, San Francisco (UCSF). Dr. Bongiovanni is establishing herself as an
investigator in patient-oriented research using implementation science to prevent the prolonged use of pain
medications in older adults in the postoperative period. Although short-term use of opioid-sparing medications
may be appropriate for postoperative pain control, long-term use in older adults can lead to adverse events
including increased risk of hospitalization and death, and should be avoided.
However, a
shift towards
multimodal pain regimens driven by the opioid epidemic has taken place without attention to ensuring that
opioid-sparing medications are discontinued appropriately.
Since older adults account for roughly half of all
surgeries in the United States, a proportion expected to increase as the population rapidly ages, a deeper
understanding of prolonged use of opioid-sparing medication is an urgent public health concern.
The
objective of this K23 proposal is to better understand and address, via a targeted, evidence-based intervention,
prolonged used of postoperative pain medication in older adults. My central hypothesis is that continuation of
pain medication postoperatively is common in older adults, has worsened as surgeons shift to multimodal
regimens, and that this phenomenon is largely due to lack of communication and coordination between care
teams and patients. The aims of this proposal are: 1. In a nationally representative Medicare population, define
the epidemiology of prolonged use of pain medications prescribed postoperatively, including patient, clinician
and health system risk factors; 2. Conduct qualitative interviews with clinicians and older adult patients and
their caregivers to document experiences of prolonged use of pain medication in the postoperative period and
obtain feedback about a planned pilot intervention to address these issues and 3. Pilot an intervention to
prevent the prolonged use of postoperative pain medication for older adults after surgery. The aims of this
proposal are developed to directly support career development activities with a focus on training in 1.
Advanced statistical analysis, specifically of Medicare data; 2. Robust qualitative methodology; 3. Design and
evaluate effective implementation strategies for older adults and 4. Career development and leadership,
focused on surgery in older adults, with the long-term goal career goal to combine her clinical and research
interests to improve postoperative care and medication use in older adults. Dr. Bongiovanni will conduct this
work with an exceptional mentoring team, led by Dr. Steinman and embedded in the UCSF Pepper Center.
This K23 proposal will advance our knowledge of the risk factors and drivers of prolonged use of pain
medication in the postoperative period, and use this knowledge to design, refine and test the feasibility and
acceptability of an intervention to prevent prolonged use for older adults. It will also provide advanced research
skills and valuable data to launch Dr. Bongiovanni’s career as an independent investigator at the intersection of
surgery and aging. Together, the data and training plan will form the basis for a compelling R01 proposal to
improve postoperative care for older adults.

Grant Number: 5K23AG073523-04
NIH Institute/Center: NIH
Principal Investigator: Tasce Bongiovanni