Postoperative opioid-prescribing practices in otolaryngology: Evidence-based guideline outcomes.

Authors

• Tanvi Rana
• Kelly Daniels
• Sophia Dang
• Jonathan C Li
• Cecilia G Freeman
• Alexander Duffy
• Joseph Curry
• Adam Luginbuhl
• Elizabeth Cottrill
• David Cognetti

Publication/Presentation Date

2-1-2023

Abstract

OBJECTIVES: We previously reported that >50% of postoperative opioids prescribed at our institution went unused for common otolaryngologic procedures. Based on these findings, we instituted multimodal, evidence-based guidelines for postoperative pain management. In the second part of our multiphasic study, we evaluated the effects of these guidelines on (1) quantity of unused opioids, (2) patient satisfaction, and (3) institutional perceptions toward the opioid epidemic and prescribing guidelines.

METHODS: Standardized, procedure-specific opioid prescription guidelines were created using prospective data from the first phase of our study and evidence from current literature. Again, we examined sialendoscopy, parotidectomy, parathyroidectomy/thyroidectomy, and transoral robotic surgery (TORS). Patients were surveyed at their first postoperative appointment. Groups from Phases I and II were compared. Attending physicians were surveyed before the start of the multiphasic project and after prescribing guidelines were implemented.

RESULTS: Prescribing guidelines led to an average reduction in prescribed morphine milligram equivalents (MME) per patient by: 48% (sialendoscopy), 63% (parotidectomy), 60% (para/thyroidectomy), and 42% (TORS). Average used MME per patient for parotidectomy was significantly reduced (64%). The proportion of unused MME per patient and patient satisfaction scores did not significantly change after guidelines were implemented.

CONCLUSION: Implementation of opioid-prescribing guidelines and the use of multimodal analgesia substantially reduced the amount of opioids prescribed across all procedures without impacting patient satisfaction.

LEVEL OF EVIDENCE: 2.

Volume

8

Issue

1

First Page

313

Last Page

321

ISSN

2378-8038

Published In/Presented At

Rana, T., Daniels, K., Dang, S., Li, J. C., Freeman, C. G., Duffy, A., Curry, J., Luginbuhl, A., Cottrill, E., & Cognetti, D. (2022). Postoperative opioid-prescribing practices in otolaryngology: Evidence-based guideline outcomes. Laryngoscope investigative otolaryngology, 8(1), 313–321. https://doi.org/10.1002/lio2.990

Disciplines

Medicine and Health Sciences

PubMedID

36846420

Department(s)

Department of Surgery

Document Type

Article