Opioid Prescribing Patterns among Otolaryngologists

Schwartz, Marissa; Naples, James G.; Kuo, Chia‐Ling; Falcone, Todd E.

doi:10.1177/0194599818757959

Cited by 82 publications

(120 citation statements)

References 23 publications

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“…Prescribing opioids following ESS is commonplace in the United States, with as many as 94% of otolaryngologists prescribing opioids after this procedure . This practice is problematic, because even a short course of opioids after minor surgery has been associated with an increased likelihood of persistent opioid use at 1 year, and the risk of long‐term opioid use increases with each additional day of opioids supplied beyond 3 days . Despite recent calls to action by the Centers for Disease Control and Prevention for changes in opioid‐prescribing behaviors, and numerous studies supporting the effectiveness of nonopioid analgesia for postoperative pain control following ESS, most otolaryngologists continue to prescribe opioids following this procedure .…”

Section: Discussionmentioning

confidence: 99%

“…However, there is currently no agreement on pain management following ESS. Although nonopioid medications are gaining increasing support in the literature, opioids are still commonly utilized to better control pain, accelerate patient recovery, and hasten return to normal activities . Recent studies by Jafari et al and Raikundalia et al determined that opioid use following ESS may be affected by surgical and nonsurgical factors, and that these may be used to tailor opioid prescriptions based on predicted levels of postoperative discomfort …”

Section: Introductionmentioning

confidence: 99%

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Quantifying the use of opioids in the immediate postoperative period after endoscopic sinus surgery

et al. 2019

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Objectives/Hypothesis: The opioid crisis is a public health emergency. There is limited evidence regarding how much opioid medication is necessary and which patients will require additional pain medication following endoscopic sinus surgery (ESS). The objective of this study was to quantify the use of opioids in the first 24 hours following ESS and determine the risk factors associated with increased need for opioid analgesia.Study Design: Retrospective chart review.Methods: A review of opioid-naïve patients routinely admitted to the hospital following ESS between June 2016 and August 2018 was performed. Opioid consumption was quantified for each patient and converted to a morphine milligram equivalents (MME) dose. Pain intensity scores were also recorded throughout the postoperative period. Sociodemographic characteristics as well as surgical procedures performed were evaluated for impact on MME.Results: A total of 130 patients (45.4% female) were included for analysis. The mean opioid dose consumed per patient in the first 24 hours following ESS was 24.1 MME, and the mean pain intensity was 2.4/10. Increasing pain scores were strongly associated with increasing MME (R = 0.78, P < .001). Multiple linear regression identified that patients taking antidepressants required an additional 17.2 MME (95% confidence interval [CI]: 5.5-28.9, P = .004) in the first 24 hours following ESS, whereas patients undergoing papilloma resection required an additional 16.9 MME (95% CI: 2.5-31.4, P = .022).Conclusions: Patients undergoing ESS require different amounts of opioids for pain control in the immediate postoperative period. A history of antidepressant use and inverted papilloma resection during ESS were associated with increased opioid consumption postoperatively.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Quantifying the use of opioids in the immediate postoperative period after endoscopic sinus surgery

et al. 2019

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“…In a study by Arianpour et al using the Centers for Medicare and Medicaid Services database, researchers found that rhinologists on average prescribed 5.4 days of opioids after FESS, with variations depending on surgeon age, experience, and demographics . Schwartz et al surveyed members of the American Academy of Otolaryngology–Head and Neck Surgery, and found that the number of narcotics prescribed ranged from zero to 60; 13% of respondents prescribed no narcotic medication, and 50% prescribed 21 tablets or greater …”

Section: Introductionmentioning

confidence: 99%

“…7 Schwartz et al surveyed members of the American Academy of Otolaryngology-Head and Neck Surgery, and found that the number of narcotics prescribed ranged from zero to 60; 13% of respondents prescribed no narcotic medication, and 50% prescribed 21 tablets or greater. 8 With the great deal of variation in opioid prescribing practices after FESS, there is a need for a better understanding of patient opioid usage and the clinical and demographic factors that can influence opioid intake. For example, it is unclear if patients undergoing more extensive sinus surgery or concurrent septoplasty require more postoperative opioids.…”

Section: Introductionmentioning

confidence: 99%

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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“…In response to this, many surgical subspecialties have tried to standardize prescribing practices and develop perioperative protocols for routine surgical procedures to guide prescribers. Otolaryngology has been no exception, and a quick review of the literature can find a number of articles reporting prescribing practices, alternate nonopioid regimens, and surveys of prescribers in all age groups and subspecialties . Despite this, there is no consensus on postoperative pain management for routine otolaryngology procedures.…”

Section: Introductionmentioning

confidence: 99%

Impact of perioperative pain management protocol on opioid prescribing patterns

et al. 2019

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Objectives/Hypothesis: The objective of this study was to demonstrate the impact of preoperative education, patient risk stratification, and a postoperative pain management protocol for common head and neck procedures on opioid prescribing patterns and postoperative pain reporting.Study Design: Retrospective cohort study. Methods: A postoperative pain management protocol was developed and implemented for patients undergoing head and neck surgical procedures. Medical charts were queried and postoperative patient satisfaction surveys were administered. Opioid prescribing patterns were evaluated in cohorts of patients undergoing procedures with anticipated mild pain (e.g., thyroidectomy, parotidectomy, lymph node biopsy) before and after the implementation of the protocol. Postoperative patient surveys were analyzed in the postimplementation group.Results: A total of 302 patients were included for analysis. One hundred fifty-four patients and 148 patients underwent surgery before and after the implementation of the protocol, respectively. There was a decreased incidence of oxycodonecontaining prescriptions (83% to 26%), and tramadol became the most common discharge medication (70%). There was a significant decrease in the total number of pills prescribed after the implementation of the protocol (34.71 to 25.36, P < .001). Ninety percent of patients reported high satisfaction (≥8) with pain management.Conclusions: This study shows that a comprehensive pain management protocol can significantly reduce the amount and potency of opioid pain medication prescribed after head and neck procedures while maintaining high patient satisfaction.

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Opioid Prescribing Patterns among Otolaryngologists

Cited by 82 publications

References 23 publications

Quantifying the use of opioids in the immediate postoperative period after endoscopic sinus surgery

Quantifying the use of opioids in the immediate postoperative period after endoscopic sinus surgery

Factors associated with opioid use after endoscopic sinus surgery

Impact of perioperative pain management protocol on opioid prescribing patterns

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