Impact of Non-Pharmacological Interventions on Patient Experience, Opioid Use, and Healthcare Utilization in Adult Cardiac Surgery: A Randomized Controlled Mixed Methods Trial
Year: 2025
Type: article
Study designs: Randomized Controlled Trial, Clinical Trial
Abstract: Non-pharmacological techniques designed to reduce anxiety, pain, and healthcare utilization have shown effectiveness in pediatric and non-surgical adult populations; however, their application has not been widely evaluated among adult surgical patients. This study randomized opioid-naive adults undergoing first-time, elective cardiac surgery to receive either targeted interventions from a trained “comfort coach” or usual care. The primary outcome assessed was healthcare utilization, specifically measured as the number of days at home within the first 30 days post-surgery. Secondary outcomes included postoperative opioid use and patient-reported outcomes, collected via validated surveys. Additionally, 50 participants in the intervention group completed semi-structured qualitative interviews to explore their experience and acceptability of the intervention. Among the 160 randomized subjects (COACH: n = 77; USUAL CARE: n = 79), three did not undergo surgery and one was excluded for dementia, leaving 156 participants with a mean age of 63 years, 33% of whom were female. The primary outcome was not statistically different between groups, with the COACH group averaging 22.8 ± 4.4 days at home and the USUAL CARE group 22.0 ± 4.5 days (p = 0.26). Both groups exhibited similar decreases in anxiety and depression from preoperative clinic to 90-days postoperatively, and discharge pain scores averaged below 3/10. Notably, opioid prescriptions were larger than patient-reported consumption (p < 0.001). Qualitative analysis revealed the comfort coach intervention was highly valued, with participants identifying positive themes regarding the role and impact of the coach. These findings suggest that a comfort coach is a valued, novel healthcare role for cardiac surgery patients, and further research should prioritize comprehensive patient-reported outcomes.
Source: Patient Experience Journal
Authors: Julie R. Piazza, Alexander A. Brescia, Jessica N. Jenkins, Alexander J. Ivacko, Xiaoting Wu, Sara M. Jafri, Christopher J. Varlamos, James C. Piazza, Lindsay K. Heering, Stefanie L. Peters, Molly Dwyer-White, Bailey H. Brown, Faraz N. Longi, Katelyn P. Monaghan, Frederick W. Bauer, Varun G. Kathawate, Melissa C. Webster, Amanda M. Kasperek, Nickole L. Garvey, Claudia Schwenzer, Kiran H. Lagisetty, Michelle Riba, Donald S. Likosky, Jennifer F. Waljee, Nicholas H. Osborne, Mary E. Byrnes, G. Michael Deeb
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4416263387
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