National Trends in Opioid Prescriptions Following Outpatient Otologic Surgery, 2005‐2017

Abstract

Objective To describe opioid stewardship in ambulatory otologic surgery from 2005 to 2017. Study Design Descriptive study of US private insurance claims. Setting Nationwide deidentified private insurance claims database (Clinformatics DataMart; Optum). Methods A total of 17,431 adult opioid-naïve outpatients were included in the study. Patients were identified from CPT-4 codes ( Current Procedural Terminology, Fourth Edition) as having undergone middle ear or mastoid surgery. Multiple regression was used to determine sociodemographic and geographic predictors of postoperative morphine milligram equivalents (MMEs) prescribed, including procedure type, year of procedure, age, sex, education, income level, and geographic region of the United States. Results The mean prescribed perioperative dose over the examined period was 203.03 MMEs (95% CI, 200.27-205.79; 5-mg hydrocodone pill equivalents, 40.61). In multivariate analysis, patients undergoing mastoid surgery were prescribed more opioids than those undergoing middle ear surgery (mean difference, 39.89 MME [95% CI, 34.37-45.41], P < .01; 5-mg hydrocodone pill equivalents, 8.0). Men were prescribed higher doses than women (mean difference, 15.39 [95% CI, 9.87-20.90], P < .01; 5-mg hydrocodone pill equivalents, 3.1). Overall MMEs prescribed by year demonstrates a sharp drop in MMEs from 2015 to 2017. Conclusion While the amount of opioids prescribed perioperatively has declined in recent years, otologists should continue to be cognizant of potential overprescribing in light of previous studies of patients’ relatively low opioid intake.

Opioid Prescriptions Following Otologic Surgery: A Population‐Based Study

“…Finally, our findings show that the amount of opioids prescribed decreased sharply in the most recent years of the study (2018‐2019). This finding reveals a similar trend to a nationwide otologic study conducted in the United States 17 . This downward trend could reflect the increasing national dialogue to control the opioid epidemic.…”

“…This finding is consistent with an American study showing that increasing income is associated with smaller doses of opioids in comparison with the lowest income brackets. 17 These income-level disparities in a public health care database increase the risk of opioid-related harms and may be influenced by provider perceptions and patient-specific factors. 16…”

“…This contrasts with the American study that showed younger patients receiving more opioids. 17 Patients aged \18 years were excluded in that study, whereas our findings include all ages. Pediatric patients are less likely than older patients to be prescribed opioids postoperatively.…”

“…This finding is consistent with an American study showing that increasing income is associated with smaller doses of opioids in comparison with the lowest income brackets. 17 These income-level disparities in a public health care database increase the risk of opioid-related harms and may be influenced by provider perceptions and patient-specific factors. 16 Regarding the influence of age in higher opioid dose prescriptions, our data suggest that increasing age at first surgery (per 10-year increase) was associated with higher opioid dose prescribed.…”

“…This finding reveals a similar trend to a nationwide otologic study conducted in the United States. 17 This downward trend could reflect the increasing national dialogue to control the opioid epidemic. In several other surgical fields, sufficient postoperative pain control with NSAIDs (nonsteroidal anti-inflammatory drugs) has shown to be comparable or even superior to opioids in randomized studies and meta-analyses.…”