Incidence and predictive factors for additional opioid prescription after endoscopic sinus surgery

Jafari, Aria; Shen, Sarek; Bracken, David; Pang, John; DeConde, Adam S.

doi:10.1002/alr.22150

Cited by 24 publications

(44 citation statements)

References 26 publications

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“…This does not come as a surprise considering septoplasty often requires a separate incision along with disruption of septal bone and cartilage. However, Jafari et al found that concomitant septoplasty with FESS did not increase the incidence of opioid refill requests . One possible explanation for the discrepancy compared to our findings is that the aforementioned study reported the number of refills, whereas we specifically looked at the number of tablets consumed.…”

Section: Discussioncontrasting

confidence: 95%

“…Recent studies have advocated for restraint in opioid prescription practices following sinus surgery. For example, Jafari et al found no differences in opioid requirements in patients who underwent extended sinus procedures compared to those who did not . A study surveying the postoperative course following FESS in 46 patients found that 63% of these patients completely ceased narcotic medication usage by postoperative day 7.…”

Section: Introductionmentioning

confidence: 99%

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Factors associated with opioid use after endoscopic sinus surgery

Raikundalia

Cheng

Truong³

et al. 2019

The Laryngoscope

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Objectives/Hypothesis Responsible prescribing of postoperative pain medications is necessary in combatting the current opioid epidemic in the United States. The goal of this study was to determine which clinical factors affect opioid usage following functional endoscopic sinus surgery (FESS). Study Design Retrospective medical records study. Methods This is a single‐institution retrospective study of subjects undergoing FESS by the senior author between September 2016 and December 2017. Opioid usage was assessed for each patient at the first postoperative visit. Univariate and multivariable analyses were performed to investigate factors associated with pain medication usage. Patients using opioids prior to surgery were excluded. Results A total of 136 patients were stratified into three groups based on number of opioid tablets taken during the first week after surgery: 31 patients (23%) took no opioids, 61 patients (45%) took one to five tablets, and 44 patients (32%) took more than five tablets. Gender, extent of surgery, revision surgery, polyp status, and cystic fibrosis did not significantly vary between the three groups. Multinomial logistic regression analysis with backward stepwise variable selection method revealed that those who had septoplasty (odds ratio [OR]: 4.84, 95% confidence interval [CI]: 1.68‐13.98; P < .01) or were of younger age (OR 0.96, 95% CI: 0.93‐0.99; P = .01) had significantly higher odds of taking >5 tablets. Conclusions The majority of patients undergoing FESS did not take more than 5 opioid tablets after surgery. Concurrent septoplasty and younger age were associated with increased opioid usage. Knowledge of such factors can help surgeons to assess opioid prescribing patterns and to counsel their patients on postoperative pain.Laryngoscope, 129:1751–1755, 2019

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Section: Discussioncontrasting

confidence: 95%

Section: Introductionmentioning

confidence: 99%

Factors associated with opioid use after endoscopic sinus surgery

Raikundalia

Cheng

Truong³

et al. 2019

The Laryngoscope

View full text Add to dashboard Cite

show abstract

“…However, a wide range of methods, statistical analyses, and patient populations were utilized in those studies. Some of the studies looked at categorical use of opioids (no tablets used vs more than one tablet used, refills vs none); others assessed smaller cohort sizes, which could have potentially missed significant differences, or heterogeneous groups, where, for example, patients who underwent septoplasty with turbinoplasty and those who underwent septoplasty without turbinoplasty were included in the same group . Nevertheless, there is much to gain by looking at the similarities and differences in those studies.…”

Section: Discussionmentioning

confidence: 99%

Prescription patterns and opioid usage in sinonasal surgery

Newberry

Casazza

Pruitt

et al. 2019

Int Forum Allergy Rhinol

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Background Excess opioid use after surgery contributes to opiate misuse and diversion. Understanding opioid prescribing and utilization patterns after sinonasal surgery is critical in designing effective practice protocols. In this study we aim to identify factors associated with variable opioid usage and further delineate optimal prescription patterns for sinonasal surgery. Methods All patients undergoing sinonasal surgery within a single health‐care system from March 2017 to August 2018 were sent electronic postoperative surveys. Data were collected on the amount of opioid required, pain control, presurgical opiate use, and narcotic disposal. Additional data collected from the electronic medical record included demographics, type of surgery performed, and total amount of opioid prescribed, including refills. Results Three‐hundred sixty four patients were included. A mean number of 25.3 tablets were prescribed per patient, yet the mean taken was just 11.8 tablets. Excess opioids were prescribed 84.9% of the time with a mean excess narcotic in oral morphine equivalents of 152.5. Among patients, 11.8% reported using no opioids, whereas 52.1% used <50% and 36.1% used >50% of their narcotic prescription. Patients used 9.3% of their full prescription and only 2.6% required a refill. The amount used was not associated with complexity of endoscopic sinus surgery, type of opiate prescribed, gender, distance living from hospital, or current opioid usage before surgery (p > 0.05). The addition of septoplasty and/or turbinoplasty was associated with variation in opioid usage (p < 0.001). A total of 76.1% of patients incorrectly discarded/stored excess opiates. Conclusion Opioids are overprescribed after sinonasal surgery. The amount of postoperative opiate prescribed should be greatly reduced and may be based on the specific procedures performed. Improved patient education regarding disposal of excess narcotics may help to curtail future opioid diversion.

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“…In our study, 4.1% of patients received an opioid prescription refill within 2 weeks after ESS. A prior study of 121 patients found that 18% of patients received an additional prescription within 60 days of ESS . Annually, 500 hospital revisits are estimated to be due to inadequate pain control after ESS, which results in significant burden for the health system and to patients .…”

Section: Discussionmentioning

confidence: 99%

“…A prior study of 121 patients found that 18% of patients received an additional prescription within 60 days of ESS. 16 Annually, 500 hospital revisits are estimated to be due to inadequate pain control after ESS, which results in significant burden for the health system and to patients. 17 Accurately predicting postoperative analgesic requirements is therefore essential for the overall success of a new postoperative pain control strategy for our specialty.…”

Section: Discussionmentioning

confidence: 99%

Opioid prescription patterns and use among patients undergoing endoscopic sinus surgery

et al. 2018

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Objectives/Hypothesis Opioid‐related deaths in the United States have increased 200% since 2000, in part due to prescription diversion from patients who had a surgical procedure. The purpose of this study was to characterize provider prescription patterns and assess patient‐reported opioid use after endoscopic sinus surgery (ESS). Study Design Retrospective chart review. Methods Patients who underwent ESS between May 2017 and May 2018 were included. Opioid prescription, operative details, and postoperative opioid use data were extracted. The Massachusetts Prescription Awareness Tool (MassPAT) was queried to determine if patients filled their prescription. Results One hundred fifty‐five patients were included. Nearly all patients received an opioid prescription (94.8%). An average of 15.6 tablets was prescribed per patient. Among 116 patients with MassPAT data, 91.4% filled their prescription. Among 67 patients who reported the number of tablets they had used at the time of first follow‐up appointment, 73.1% reported taking no opioids. Mean number of tablets prescribed was significantly greater among patients who underwent primary versus revision surgery (16.5 vs. 13.5, P = .0111) and those who had splints placed (21.5 vs. 15.1, P = .0037). Predictors of opioid use included concurrent turbinate reduction (58.3% vs. 14.3%, P < .0001) and concurrent septoplasty (45.5% vs. 21.6%, P = .039). Conclusions Nearly all patients who underwent ESS were prescribed an opioid, and nearly all patients filled their prescription. However, the vast majority of patients did not require any opioid medication for postoperative pain control. As the opioid epidemic continues to persist, these findings have immediate relevance to current prescribing patterns and pain management practices. Level of Evidence 4 Laryngoscope, 129:1046–1052, 2019

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Incidence and predictive factors for additional opioid prescription after endoscopic sinus surgery

Abstract: A need for extension of postoperative opioid pain control is not uncommon after ESS. Patient baseline clinical characteristics are predictive of a need for re-prescription of opioids. Surgical extent is not associated with need for prolonged postoperative opioid pain management.

Cited by 24 publications

References 26 publications

Factors associated with opioid use after endoscopic sinus surgery

Factors associated with opioid use after endoscopic sinus surgery

Prescription patterns and opioid usage in sinonasal surgery

Opioid prescription patterns and use among patients undergoing endoscopic sinus surgery

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