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Implementation of Opioid-Free Thyroid and Parathyroid Procedures: A Single Center Experience.
J Surg Res. 2020 08; 252:169-173.JS

Abstract

BACKGROUND

Initial opioid exposure for most individuals with substance use disorder comes from the healthcare system, and overprescription of opioids in ambulatory operations is common. This report describes an academic medical center's experience implementing opioid-free thyroid and parathyroid operations.

MATERIALS AND METHODS

This is a retrospective chart review of patients undergoing a thyroid or parathyroid operation before and after implementation of an opioid-free analgesia protocol. The primary endpoint was new postoperative opioid prescription. Secondary endpoints included prescription characteristics and predictors of new opioid prescription.

RESULTS

A total of 515 patients were enrolled in the study: 240 in the control or "pre-intervention" cohort (May through October 2017) and 275 in the intervention or "post" cohort (May through October 2018). Patients in the intervention cohort were significantly less likely to receive an opioid prescription (12.0% versus 59.6%, P < 0.001). When opioids were prescribed, they were used for shorter durations and at lower doses in the intervention cohort. Among the patients prescribed opioids in the intervention cohort (N = 33), the only significant predictor of postoperative opioid use was preoperative opioid use (P = 0.001).

CONCLUSIONS

Opioids may not be required after thyroidectomy and parathyroidectomy, especially for opioid-naïve patients. Future research should examine patient satisfaction with opioid-sparing analgesia.

Authors+Show Affiliations

Department of Pharmacy Practice and Science, University of Kentucky College of Pharmacy, Lexington, Kentucky. Electronic address: doug.oyler@uky.edu.Department of Surgery, University of Kentucky College of Medicine, Lexington, Kentucky.Department of Surgery, University of Kentucky College of Medicine, Lexington, Kentucky.University of Kentucky College of Pharmacy, Lexington, Kentucky.Department of Surgery, University of Kentucky College of Medicine, Lexington, Kentucky.Department of Surgery, University of Kentucky College of Medicine, Lexington, Kentucky.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32278971

Citation

Oyler, Douglas R., et al. "Implementation of Opioid-Free Thyroid and Parathyroid Procedures: a Single Center Experience." The Journal of Surgical Research, vol. 252, 2020, pp. 169-173.
Oyler DR, Randle RW, Lee CY, et al. Implementation of Opioid-Free Thyroid and Parathyroid Procedures: A Single Center Experience. J Surg Res. 2020;252:169-173.
Oyler, D. R., Randle, R. W., Lee, C. Y., Jenkins, G., Chang, P. K., & Sloan, D. A. (2020). Implementation of Opioid-Free Thyroid and Parathyroid Procedures: A Single Center Experience. The Journal of Surgical Research, 252, 169-173. https://doi.org/10.1016/j.jss.2020.03.010
Oyler DR, et al. Implementation of Opioid-Free Thyroid and Parathyroid Procedures: a Single Center Experience. J Surg Res. 2020;252:169-173. PubMed PMID: 32278971.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Implementation of Opioid-Free Thyroid and Parathyroid Procedures: A Single Center Experience. AU - Oyler,Douglas R, AU - Randle,Reese W, AU - Lee,Cortney Y, AU - Jenkins,Grace, AU - Chang,Phillip K, AU - Sloan,David A, Y1 - 2020/04/09/ PY - 2019/12/03/received PY - 2020/02/04/revised PY - 2020/03/08/accepted PY - 2020/4/13/pubmed PY - 2020/9/10/medline PY - 2020/4/13/entrez KW - Opioid KW - Pain management KW - Parathyroid KW - Thyroid SP - 169 EP - 173 JF - The Journal of surgical research JO - J Surg Res VL - 252 N2 - BACKGROUND: Initial opioid exposure for most individuals with substance use disorder comes from the healthcare system, and overprescription of opioids in ambulatory operations is common. This report describes an academic medical center's experience implementing opioid-free thyroid and parathyroid operations. MATERIALS AND METHODS: This is a retrospective chart review of patients undergoing a thyroid or parathyroid operation before and after implementation of an opioid-free analgesia protocol. The primary endpoint was new postoperative opioid prescription. Secondary endpoints included prescription characteristics and predictors of new opioid prescription. RESULTS: A total of 515 patients were enrolled in the study: 240 in the control or "pre-intervention" cohort (May through October 2017) and 275 in the intervention or "post" cohort (May through October 2018). Patients in the intervention cohort were significantly less likely to receive an opioid prescription (12.0% versus 59.6%, P < 0.001). When opioids were prescribed, they were used for shorter durations and at lower doses in the intervention cohort. Among the patients prescribed opioids in the intervention cohort (N = 33), the only significant predictor of postoperative opioid use was preoperative opioid use (P = 0.001). CONCLUSIONS: Opioids may not be required after thyroidectomy and parathyroidectomy, especially for opioid-naïve patients. Future research should examine patient satisfaction with opioid-sparing analgesia. SN - 1095-8673 UR - https://www.unboundmedicine.com/medline/citation/32278971/Implementation_of_Opioid_Free_Thyroid_and_Parathyroid_Procedures:_A_Single_Center_Experience_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-4804(20)30126-8 DB - PRIME DP - Unbound Medicine ER -