Opioid Prescriptions Following Otologic Surgery: A Population‐Based Study

Kirubalingam, Keshinisuthan; Nguyen, Paul; Klar, Gregory; Dion, Joanna M.; Campbell, Robert J.; Beyea, Jason A.

doi:10.1177/01945998211045364

Cited by 6 publications

(9 citation statements)

References 24 publications

(79 reference statements)

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“…Large variations in prescribing have also been observed in patients in Ontario who underwent otologic surgery. 40 The variation in agent filled is also noteworthy, as some patients in our cohort received powerful narcotics such as oxycodone, hydromorphone and morphine, known to contribute to opioid -related deaths in Ontario. 41 An approach that reduces narcotic prescribing can be successfully introduced and implemented.…”

Section: Discussionmentioning

confidence: 97%

Variation in opioid filling after same-day breast surgery in Ontario, Canada: a population-based cohort study

La¹,

Alqaydi²,

Wei³

et al. 2023

cmajo

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he rising use and misuse of opioids is a national and international crisis that contributes significantly to opioid-related deaths, particularly in young adults. 1,2 In Canada, between January 2016 and June 2019, there were more than 13 900 apparent opioid-related deaths and 17 000 opioid-related hospital admissions. 3 In Canada and the United States, physicians prescribe higher quantities of opioids than in other countries 4,5 and the amount prescribed is often greater than is needed, as evidenced by the large numbers of unused opioids. 6,7 This may lead to longterm use in opioid-naive patients, 8,9 misuse by others in the household 10,11 and diversion (i.e., transfer of a medication from a lawful to unlawful distribution or use). 12 Surgeons commonly prescribe opioid analgesics to treat acute postoperative pain. In the US, despite writing only 1.8% of all medication prescriptions, surgeons accounted for 9.8% of all opioid prescriptions. 13 Breast cancer is the most common cancer in women in Canada, occurring in 1 in 8 females, with 27 000 new cases in 2019. 14 Breast surgery is commonly used to treat benign and malignant conditions. Postoperative pain management practices in breast surgery are variable among surgeons in the US, 15,16 with high rates of opioid analgesic overprescription, 5 despite recent literature that suggests 5 days is the appropriate length of time that opioids should be prescribed for breast surgery, if prescribed at all. 17 A recent Canadian study showed that patients undergoing breast surgery can achieve adequate pain control with minimal to no postoperative opioids. 18 To better evaluate prescribing practices, the Ontario Ministry of Health and Long-Term Care mandated data collection on Variation in opioid filling after same-day breast surgery in Ontario, Canada: a population-based cohort study

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Section: Discussionmentioning

confidence: 97%

Variation in opioid filling after same-day breast surgery in Ontario, Canada: a population-based cohort study

La¹,

Alqaydi²,

Wei³

et al. 2023

cmajo

View full text Add to dashboard Cite

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“…As our cohort demonstrated similar behavior, the risk of subsequent misuse or diversion is prevalent and presents great opportunity for patient education about proper opioid disposal. Recently, opioid prescribing guidelines have been successfully employed to reduce opioid excess, and the average postoperative MME prescribed has declined each year since 2015 15,19,35‐37 …”

Section: Discussionmentioning

confidence: 99%

“…Recently, opioid prescribing guidelines have been successfully employed to reduce opioid excess, and the average postoperative MME prescribed has declined each year since 2015. 15,19,[35][36][37] As otolaryngologists reduce opioid prescriptions, there is a need to validate alternative therapies that appropriately manage postoperative pain and maintain patient satisfaction. Several studies suggest that many ambulatory surgeries can be managed without opioids and that otologic surgeries confer mild postoperative pain.…”

Section: Discussionmentioning

confidence: 99%

Multimodal Analgesia and Patient Education Reduce Postoperative Opioid Consumption in Otology

Butkus

Awosanya

Scott

et al. 2023

Otolaryngol.--head neck surg.

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Objective This study sought to validate alternative pain management strategies that can reduce reliance on opioids for postoperative pain management in otology. Study Design Prospective cohort study. Setting Single tertiary‐care facility. Methods Adult patients who underwent outpatient otologic surgery from September 2021 to July 2022 were randomized into treatment cohorts. The opioid monotherapy cohort received a standard opioid prescription. The multimodal analgesia cohort received the same opioid prescription, prescriptions for acetaminophen and naproxen, and additional pain management education with a flyer on discharge. All patients completed a questionnaire 1 week after surgery to evaluate opioid usage and pain scores. Results Eighty‐six patients completed the study. The opioid monotherapy cohort (n = 42) and multimodal analgesia cohort (n = 44) were prescribed an average of 42.1 ± 20.4 morphine milligram equivalents (MME) and 38.4 ± 5.7 MME, respectively (p = 0.373). Four patients (9.52%) in the opioid monotherapy cohort required opioid refills compared to 1 patient (2.27%) in the multimodal analgesia cohort (p = 0.156). Multivariate analysis demonstrated that the multimodal analgesia cohort consumed significantly fewer opioids on average than the opioid monotherapy cohort (11.9 ± 15.9 MME vs 22.8 ± 28.0 MME, respectively). There were no significant differences in postoperative rehospitalizations (p = 0.317) or Emergency Department visits (p = 0.150). Pain scores on the day of surgery, postoperative day (POD) 1, POD3, and POD7 were not significantly different between cohorts (p = 0.395, 0.896, 0.844, 0.765, respectively). Conclusion The addition of patient education, acetaminophen, and naproxen to postoperative opioid prescriptions significantly reduced opioid consumption without affecting pain scores, refill rates, or complication rates after otologic surgery.

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“…Satisfactory postoperative pain control can be achieved pharmacologically by single or combinations of drugs. A word of caution: there are several recent reports on excessive opioid prescription practices after otologic operations (20)(21)(22), with recommendations that these drugs be avoided because of their association with chronic pain disorder and substance abuse. It had been suggested (23) and demonstrated (24) that routine opioid prescription after middle ear surgery can be avoided without a resultant pain-control compromise.…”

Section: Control Of Postoperative Painmentioning

confidence: 99%

Preoperative Anxiety Levels and Postoperative Middle Ear Surgery Pain Levels

et al. 2023

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ObjectiveThis study aimed to characterize self-reported postoperative pain after tympanoplasty and tympanomastoidectomy and correlate pain severity with the patient's preoperative anxiety state.Study DesignProspective cohort study.SettingTertiary referral medical center.PatientsAdult patients undergoing any middle ear surgery between July 2018 and July 2019.Main Outcome MeasuresPatient responses to an otology questionnaire (OQ) for scoring pain intensity on a visual analog scale preoperatively and on postoperative days (PODs) 1–4, 21, and 63. The responses were correlated with anxiety state (assessed by State-Trait Personality Inventory [STPI] scores) and clinical and operative data, including surgical technique–related details.ResultsSixty patients were enrolled (mean age ± standard deviation, 40 ± 19.7 yr, 26 men). Their median preoperative (baseline) visual analog scale pain score was 6 on POD1, 5 on POD3, and 1 at 3 and 7 weeks. Their median preoperative OQ score was 32 of 70 (45.7%), 37 of 70 (52.8%) on POD1, 33 of 70 (47.1%) on POD3, 6 of 70 (8.5%) at 3 weeks, and 6 of 70 at 7 weeks. Their overall mean preoperative anxiety level (STPI score) was 2.63 ± 1.50. STPI scores were significantly higher among patients who reported OQ scores equal to or higher than the median during PODs 1 to 4 in comparison to patients who reported OQ scores lower than the median. The α Cronbach correlation between anxiety and postoperative pain scores on POD1 was 0.97.ConclusionPreoperative anxiety levels are closely associated with postoperative pain levels after any middle ear surgery. Measures to control preoperative anxiety are warranted to alleviate postoperative pain.

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Opioid Prescriptions Following Otologic Surgery: A Population‐Based Study

Cited by 6 publications

References 24 publications

Variation in opioid filling after same-day breast surgery in Ontario, Canada: a population-based cohort study

Variation in opioid filling after same-day breast surgery in Ontario, Canada: a population-based cohort study

Multimodal Analgesia and Patient Education Reduce Postoperative Opioid Consumption in Otology

Preoperative Anxiety Levels and Postoperative Middle Ear Surgery Pain Levels

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