Changes in Opioid Prescribing Habits for Patients Undergoing Rhinoplasty and Septoplasty

Abstract

IMPORTANCEOpioid prescriptions have increased substantially over the last 2 decades, contributing to the opioid epidemic. Physician practices and legislative changes play a key role in decreasing prescription opioid use.OBJECTIVE To evaluate changes in opioid prescribing habits for patients undergoing rhinoplasty and/or septoplasty before and after the adoption of new opioid legislation. DESIGN, SETTING, AND PARTICIPANTSThis single-institution case-control study examined opioid prescribing habits for 80 patients who were undergoing rhinoplasty and septoplasty with or without turbinate reduction at the University of Vermont between March 2016 and May 2018. Patients were excluded if they underwent concomitant endoscopic sinus surgery or were younger than 14 years. Patients were divided by surgery date before or after legislative changes on July 1, 2017.EXPOSURES Rhinoplasty and septoplasty with or without turbinate reduction.MAIN OUTCOMES AND MEASURES Patient demographics and opioid prescriptions were recorded. Patients were evaluated if they reported pain during follow-up, called the office, or received a second prescription. The Vermont Prescription Monitoring System was queried to determine if opioid prescriptions were filled within 30 days of the procedure. The 2 groups were compared to test the hypothesis that opioid prescriptions had decreased after legislative changes. RESULTSOf a total of 80 participants, the mean (SD) age in the before (15 women [37.5%]) and after (16 women [40.0%]) groups were 41.4 years and 40.6 years, respectively. There was a statistically significant decrease in the number of pills prescribed to the after group (17.5 to 9.7; P < .001) as well as a decrease in the morphine milligram equivalents that were prescribed (130.9 to 73.2; P < .001). There was no statistical difference in the number of postoperative telephone calls for pain, second prescriptions, or increased complaints of pain at the postoperative visit.CONCLUSIONS AND RELEVANCE Recent laws in Vermont regarding opioid prescribing were implemented in 2017 to curb the ongoing opioid epidemic. Our observations of patients undergoing septoplasties and rhinoplasties found a significant reduction in opioid prescriptions. This was not associated with an increase in patient complaints about postoperative pain or the need for a second prescription after surgery. This shows that we may safely be able to decrease the number of narcotic medications that we prescribe.LEVEL OF EVIDENCE 3.

Evaluating opioid analgesic prescribing limits: A narrative review

“…Patient and public health outcomes, evaluated in less than half of the studies, included changes in patient-reported pain scores or quality of life, 18,19 unplanned access to additional medical care for pain or related issues, [20][21][22][23][24][25] concomitant opioid and benzodiazepine prescribing, [26][27][28][29][30] prescription opioid or heroin overdose hospitalizations or trends, 26,31,32 transition from acute to prolonged use after surgical procedures, 18,[33][34][35][36][37] allcause mortality, 18 patient retention rate, 28 and changes in number of prescribers or pharmacies. 26,31,38 One study also evaluated prescriber utilization of an electronic medical record (EMR) alert tool designed to facilitate compliance with OA prescribing limits.…”

Differences in Need for Opioids After Sinonasal Surgery at Day of Surgery and in the Postoperative Period

“…11,21 Our results also confirm previous literature which states that a reduction of opioids still guarantees satisfactory pain control and does not lead to increased second prescriptions. 22…”

Assessing Impact: Implementing an Opioid Prescription Protocol in Otolaryngology

“…After a review of the available literature on opioid requirements after ORL surgery, a protocol was created for maximum postoperative opioid prescriptions based on anatomic site of surgery 6–36 . Of note, it was decided that pediatric patients should not receive opioid prescriptions regardless of surgical site, given the higher risk of adverse events in this patient population related to variability in opioid metabolism and risks of respiratory depression, possibly leading to death 37 .…”