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Postoperative opioid-prescribing practices in otolaryngology: A multiphasic study.
Laryngoscope. 2020 03; 130(3):659-665.L

Abstract

OBJECTIVES

In otolaryngology, postoperative pain management lacks evidence-based guidelines. We designed a prospective, multiphasic study aimed to develop evidence-based guidelines for postoperative pain management within our institution. In this first phase of our project, we investigated opioid prescription and consumption as well as pain trends for common otolaryngologic procedures.

METHODS

Patients (n = 161) who underwent procedures between July 2018 and February 2019 were surveyed on their postoperative opioid usage and pain from day of discharge to first clinic visit. Opioid prescriptions were converted to standardized units of morphine milligram equivalents (MME). The procedures selected for analysis were parathyroidectomy/thyroidectomy, parotidectomy, sialendoscopy, and transoral robotic surgery resection (TORS).

RESULTS

In total, 19,748 MME were prescribed: 8,588 MME (43.5%) were used, leaving 11,159 MME (56.5%) unused. TORS average MME used: 221 ± 227; total MME unused: 38%. Sialendoscopy average MME used: 31 ± 46; total MME unused: 67%. Parathyroidectomy/thyroidectomy average MME used: 30 ± 37; total MME unused: 66%. Parotidectomy average MME used: 43 ± 53; total MME unused: 65%. Male gender, smoking (current and former), and psychiatric medication use were positive predictors of opioid consumption in postoperative patients (P < 0.001).

CONCLUSION

At our institution, over 50% of prescribed postoperative opioids went unused. This was most pronounced for nonmucosal surgeries. Postoperative pain management should account for this to minimize unnecessary opioid prescriptions. Based on our findings and review of current literature, we are in the process of developing prescribing recommendations to be implemented within our institution.

LEVEL OF EVIDENCE

2 Laryngoscope, 130:659-665, 2020.

Authors+Show Affiliations

Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A.Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A.Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A.Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A.Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A.Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, U.S.A.Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, Pennsylvania, U.S.A.Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, U.S.A.Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, U.S.A.Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, U.S.A.Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, U.S.A.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31225905

Citation

Dang, Sophia, et al. "Postoperative Opioid-prescribing Practices in Otolaryngology: a Multiphasic Study." The Laryngoscope, vol. 130, no. 3, 2020, pp. 659-665.
Dang S, Duffy A, Li JC, et al. Postoperative opioid-prescribing practices in otolaryngology: A multiphasic study. Laryngoscope. 2020;130(3):659-665.
Dang, S., Duffy, A., Li, J. C., Gandee, Z., Rana, T., Gunville, B., Zhan, T., Curry, J., Luginbuhl, A., Cottrill, E., & Cognetti, D. (2020). Postoperative opioid-prescribing practices in otolaryngology: A multiphasic study. The Laryngoscope, 130(3), 659-665. https://doi.org/10.1002/lary.28101
Dang S, et al. Postoperative Opioid-prescribing Practices in Otolaryngology: a Multiphasic Study. Laryngoscope. 2020;130(3):659-665. PubMed PMID: 31225905.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Postoperative opioid-prescribing practices in otolaryngology: A multiphasic study. AU - Dang,Sophia, AU - Duffy,Alexander, AU - Li,Jonathan C, AU - Gandee,Zachary, AU - Rana,Tanvi, AU - Gunville,Brittany, AU - Zhan,Tingting, AU - Curry,Joseph, AU - Luginbuhl,Adam, AU - Cottrill,Elizabeth, AU - Cognetti,David, Y1 - 2019/06/21/ PY - 2019/04/23/received PY - 2019/05/13/revised PY - 2019/05/20/accepted PY - 2019/6/22/pubmed PY - 2020/8/25/medline PY - 2019/6/22/entrez KW - Postoperative opioid KW - TORS KW - evidence-based guidelines KW - head and neck KW - multimodal analgesia KW - otolaryngology KW - pain management KW - parathyroidectomy KW - parotidectomy KW - sialendoscopy KW - thyroidectomy KW - transoral robotic surgery SP - 659 EP - 665 JF - The Laryngoscope JO - Laryngoscope VL - 130 IS - 3 N2 - OBJECTIVES: In otolaryngology, postoperative pain management lacks evidence-based guidelines. We designed a prospective, multiphasic study aimed to develop evidence-based guidelines for postoperative pain management within our institution. In this first phase of our project, we investigated opioid prescription and consumption as well as pain trends for common otolaryngologic procedures. METHODS: Patients (n = 161) who underwent procedures between July 2018 and February 2019 were surveyed on their postoperative opioid usage and pain from day of discharge to first clinic visit. Opioid prescriptions were converted to standardized units of morphine milligram equivalents (MME). The procedures selected for analysis were parathyroidectomy/thyroidectomy, parotidectomy, sialendoscopy, and transoral robotic surgery resection (TORS). RESULTS: In total, 19,748 MME were prescribed: 8,588 MME (43.5%) were used, leaving 11,159 MME (56.5%) unused. TORS average MME used: 221 ± 227; total MME unused: 38%. Sialendoscopy average MME used: 31 ± 46; total MME unused: 67%. Parathyroidectomy/thyroidectomy average MME used: 30 ± 37; total MME unused: 66%. Parotidectomy average MME used: 43 ± 53; total MME unused: 65%. Male gender, smoking (current and former), and psychiatric medication use were positive predictors of opioid consumption in postoperative patients (P < 0.001). CONCLUSION: At our institution, over 50% of prescribed postoperative opioids went unused. This was most pronounced for nonmucosal surgeries. Postoperative pain management should account for this to minimize unnecessary opioid prescriptions. Based on our findings and review of current literature, we are in the process of developing prescribing recommendations to be implemented within our institution. LEVEL OF EVIDENCE: 2 Laryngoscope, 130:659-665, 2020. SN - 1531-4995 UR - https://www.unboundmedicine.com/medline/citation/31225905/Postoperative_opioid_prescribing_practices_in_otolaryngology:_A_multiphasic_study_ L2 - https://doi.org/10.1002/lary.28101 DB - PRIME DP - Unbound Medicine ER -