Opioid reduction in ambulatory thyroid and parathyroid surgery after implementing enhanced recovery after surgery protocol

Lide, Riley C.; Creighton, Erin Weatherford; Yeh, Jessica; Troughton, Mikayla; Hollowoa, Blake; Merrill, Tyler; Robbins, Alexa; Orman, Gray M.; Breckling, Meghan N.; Vural, Emre; Moreno, Mauricio A.; Stack, Brendan C.

doi:10.1002/hed.26617

Cited by 12 publications

(9 citation statements)

References 14 publications

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“…20 ERAS implementation often involves patient education, preoperative administration of non-opioid analgesia and anti-emetics, and judicious use of postoperative narcotics. 20,21 In our study, we found that only 11.2% of patients used ibuprofen postoperatively. Given the understanding that ibuprofen is a safe and valuable analgesic option, a formalized policy, such as an ERAS protocol, could serve to educate patients and improve usage rates.…”

Section: Discussionmentioning

confidence: 57%

Postoperative opioid use following head and neck endocrine surgery: A multi‐center prospective study

Hamour

Manojlovic-Kolarski

Eskander

et al. 2023

Laryngoscope Investig Oto

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Background: Opioid abuse is widespread in North America and the over-prescription of opioids are a contributing factor. The goal of this prospective study was to quantify over-prescription rates, evaluate postoperative experiences of pain, and understand the impact of peri-operative factors such as adequate pain counseling and use of non-opioid analgesia. Methods: Consecutive recruitment of patients undergoing head and neck endocrine surgery was undertaken from January 1st 2020 to December 31st 2021 at four Canadian hospitals in Ontario and Nova Scotia. Postoperative tracking of pain levels and analgesic requirements were employed. Chart review and preoperative and postoperative surveys provided information on counseling, use of local anesthesia, and disposal plans. Results: A total of 125 adult patients were included in the final analysis. Total thyroidectomy was the most common procedure (40.8%). Median use of opioid tablets was 2 (IQR 0-4), with 79.5% of prescribed tablets unused. Patients who reported inadequate counseling (n = 35, 28.0%) were more likely to use opioids (57.2% vs. 37.8%, p < .05) and less likely to use non-opioid analgesia in the early postoperative course (42.9% vs. 63.3%, p < .05). Patients who received local anesthesia peri-operatively (46.4%, n = 58) reported less severe pain on average [2.86 (2.13) vs. 4.86 (2.19), p < .05] and used less analgesia on postoperative day one [0 MME (IQR 0-4) vs. 4 MME (IQR 0-8), p < .05]. Conclusion: Over-prescription of opioid analgesia following head and neck endocrine surgery is common. Patient counseling, use of non-opioid analgesia, and peri-operative local anesthesia were important factors in narcotic use reduction.

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Section: Discussionmentioning

confidence: 57%

Postoperative opioid use following head and neck endocrine surgery: A multi‐center prospective study

Hamour

Manojlovic-Kolarski

Eskander

et al. 2023

Laryngoscope Investig Oto

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“…There is limited data on the role of ERAS in our study population. Two publications examined the role of ERAS in decreasing opioid use following PTX [ 12 13 ], but these studies did not distinguish primary hyperparathyroidism from SHPT. To the best of our knowledge, this is the first study to evaluate the role of an ERAS program in reducing the incidence of HBS among patients on hemodialysis who underwent PTX [ 12 13 ].…”

Section: Discussionmentioning

confidence: 99%

“…Two publications examined the role of ERAS in decreasing opioid use following PTX [ 12 13 ], but these studies did not distinguish primary hyperparathyroidism from SHPT. To the best of our knowledge, this is the first study to evaluate the role of an ERAS program in reducing the incidence of HBS among patients on hemodialysis who underwent PTX [ 12 13 ]. Patients on hemodialysis for ESRD have an increased risk for electrolyte imbalances, and previous studies demonstrated an association between renal impairment and hemodialysis and readmission after PTX [ 21 22 ].…”

Section: Discussionmentioning

confidence: 99%

“…The ERAS program aims to improve recovery, shorten LOS, and reduce complications, readmissions, and costs [ 10 11 ]. Studies on the benefits of ERAS programs in patients undergoing PTX are limited; existing studies only demonstrated that ERAS programs reduced opioid use following PTX [ 12 13 ]. Therefore, the present study examined whether a customized ERAS program reduced the incidence of HBS among patients on maintenance dialysis who underwent PTX for SHPT.…”

Section: Introductionmentioning

confidence: 99%

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Impact of enhanced recovery after surgery program for hungry bone syndrome in patients on maintenance hemodialysis undergoing parathyroidectomy for secondary hyperparathyroidism

Wang

Zhang

et al. 2022

Ann Surg Treat Res

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Purpose Hungry bone syndrome after parathyroidectomy is an important clinical problem in patients on maintenance hemodialysis. We examined the effect of an enhanced recovery after surgery (ERAS) program on the incidence of hungry bone syndrome after parathyroidectomy in this population. Methods This single-institution, retrospective study analyzed 108 patients on hemodialysis who underwent parathyroidectomy for secondary hyperparathyroidism. Patients were classified into the pre-ERAS (n = 52) and post-ERAS (n = 56) groups. The ERAS program identified high-risk patients and enforced aggressive measures to normalize calcium levels following parathyroidectomy. Results There was no significant difference in age, sex, body weight, presenting symptoms, preoperative calcium and alkaline phosphatase levels, postoperative intact parathyroid levels, postoperative calcium levels at 1 and 24 hours after parathyroidectomy, and 30-day readmission rates between the groups. The post-ERAS group had significantly higher levels of postoperative calcium at 48 and 72 hours after parathyroidectomy, but a lower incidence of hungry bone syndrome and shorter postoperative length of stay. Patients with hungry bone syndrome had higher preoperative levels of alkaline phosphatase and intact parathyroid, longer postoperative length of stay, and were less likely to have been part of the ERAS program. High preoperative alkaline phosphatase levels and absence of the ERAS program were independent risk factors for hungry bone syndrome after parathyroidectomy. Conclusion The ERAS program reduced the incidence of hungry bone syndrome and shortened the postoperative length of stay in patients on maintenance hemodialysis who underwent parathyroidectomy for secondary hyperparathyroidism.

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“…However, the use of dexmedetomidine during overnight thyroidectomy did not reduce the incidence of PONV at 24 hours in postoperation (p=0.355) ( 24 ). To reduce the incidence of the postoperative POVN, intraoperative cervical plexus anesthesia block, rational use of anesthetic drugs in preoperative multimodality, postoperative use of non-steroidal drugs such as Acetaminophen or Ibuprofen in combination with appropriate Opioid analgesia has a good effect on preventing postoperative POVN, which can also indirectly reduce the dosage of opioids ( 25 ). Therefore, anesthesiologists should consider more factors in the choice of anesthesia drugs and anesthesia methods and choose the types of drugs and anesthesia methods more carefully.…”

Section: The Associated Complicationsmentioning

confidence: 99%

The safety, benefits and future development of overnight and outpatient thyroidectomy

Zhang

Xia

et al. 2023

Front. Endocrinol.

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With the development of medical care, the safety of thyroidectomy is improving year by year. Due to economic benefits and other advantages of the overnight and outpatient thyroidectomy, more and more patients and medical institutions have favored overnight and outpatient thyroidectomy, and its proportion in thyroidectomy has increased year by year. However, overnight and outpatient thyroidectomy still faces many challenges and remains to be improved. In this review, we focused on the recent progress and the relevant clinical features of overnight and outpatient thyroidectomy, including its safety, economic benefits, etc., which may bring valuable clues and information for further improvements of patient benefits and promotions of overnight or outpatient thyroidectomy in the future.

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Opioid reduction in ambulatory thyroid and parathyroid surgery after implementing enhanced recovery after surgery protocol

Cited by 12 publications

References 14 publications

Postoperative opioid use following head and neck endocrine surgery: A multi‐center prospective study

Postoperative opioid use following head and neck endocrine surgery: A multi‐center prospective study

Impact of enhanced recovery after surgery program for hungry bone syndrome in patients on maintenance hemodialysis undergoing parathyroidectomy for secondary hyperparathyroidism

The safety, benefits and future development of overnight and outpatient thyroidectomy

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