In otolaryngology, postoperative pain management lacks evidence-based guidelines. We investigated opioid prescription and consumption for common procedures to develop prescribing guidelines at our institution.
Prospective, survey study.
Patients who underwent surgery between July and September were given surveys upon discharge and at first follow-up visit. We assessed opioid usage and pain using the visual analog scale and opioid consumption throughout the postoperative period. Opioid prescriptions were converted to a standardized unit of 5 mg Oxycodone pills for reporting. Four procedures (transoral robotic surgery resection [TORS], sialendoscopy, parathyroidectomy/thyroidectomy, and parotidectomy) were selected for isolated analysis.
Of the 80 surveys that met criteria for inclusion for analysis, a total of 1,954.0 pills were prescribed, with 300.3 pills (15.4%) reported having been used by patients, leaving 1,653.7 pills (84.5%) unused. TORS (n=12) average pills used: 4.9 ± 5.9 (95% CI: 1.6-8.3); total % pills unused: 89.3%. Sialendoscopy (n=13) average pills used: 4.2 ± 5.1 (95% CI: 1.1-7.4); total % pills unused: 72.5%. Parathyroidectomy/thyroidectomy (n=22) average pills used: 3.1 ± 4.4 (95% CI: 1.7-5.5); total % pills unused: 79.2%. Parotidectomy (n=12) average pills used: 1.3 ± 2.5 (95% CI: 0.7-4.3); total % pills unused: 94.7%.
At our institution, opioids for ((postoperative otolaryngology)) patients’ pain management in otolaryngologic procedures were prescribed in excess with 84.5% reported as unused. Procedure-specific opioid diversion pool ranged from 72.5%-94.7%. Our findings provide a foundation for procedure-specific evidence-based opioid prescription guidelines.
Gandee, Zachary; Dang, Sophia; Duffy, Alexander N.; Li, Jonathan C.; Rana, Tanvi; Gunville, Brittany; Zhan, Tingting; Cottrill, Elizabeth; and Cognetti, David, "Opioid-Prescribing Practices for Post-Operative Patients in Otolaryngology: A Multiphasic Quality Improvement Project in a Single Large Institution" (2018). SKMC JeffMD Scholarly Inquiry, Phase 1, Project 1.