A Prospective Evaluation of Postoperative Opioid Use in Otologic Surgery

Qian, Z Jason; Alyono, Jennifer C; Woods, Ong-Dee; Ali, Noor Azman; Blevins, Nikolas H.

doi:10.1097/mao.0000000000002364

Cited by 21 publications

(41 citation statements)

References 15 publications

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“…The average opioid prescription consisted of ~41 pills (5-mg hydrocodone equivalents), while previous studies have shown that <10 pills were consumed after otologic surgery. 6-8 This study also revealed clinical and sociodemographic factors that contribute to high opioid prescriptions.…”

Section: Discussionmentioning

confidence: 64%

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

Cooperman¹,

Jin²,

Qian³

et al. 2021

Otolaryngol.--head neck surg.

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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.

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Section: Discussionmentioning

confidence: 64%

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

Cooperman¹,

Jin²,

Qian³

et al. 2021

Otolaryngol.--head neck surg.

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“…There were 24 studies identified, including 6 RCTs, 13 prospective observational studies, and 5 retrospective observational studies, that described mean or median consumption with either the standard deviation or the 75th percentile. 147,152,153,164-185 Opioid consumption was initially converted into morphine milligram equivalent (MME) units 186 ( Table 15 ), and individual procedures were compared. MME is a value assigned to compare the opioid dosage equivalency to another opioid.…”

Section: Key Action Statementsmentioning

confidence: 99%

“…164 c Two studies reported opioid consumption in aggregate for various otology procedures (tympanoplasty, tympanomastoidectomy, cochlear implantation, and stapedectomy), and only transcanal procedures were found to have lower opioid consumption. 176,177 d Data represent the 75th percentile. No ~85th percentile data were available for these procedures. …”

Section: Key Action Statementsmentioning

confidence: 99%

Clinical Practice Guideline: Opioid Prescribing for Analgesia After Common Otolaryngology Operations

Anne¹,

Mims

Tunkel

et al. 2021

Otolaryngol.--head neck surg.

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Objective Opioid use disorder (OUD), which includes the morbidity of dependence and mortality of overdose, has reached epidemic proportions in the United States. Overprescription of opioids can lead to chronic use and misuse, and unused narcotics after surgery can lead to their diversion. Research supports that most patients do not take all the prescribed opioids after surgery and that surgeons are the second largest prescribers of opioids in the United States. The introduction of opioids in those with OUD often begins with prescription opioids. Reducing the number of extra opioids available after surgery through smaller prescriptions, safe storage, and disposal should reduce the risk of opioid use disorder in otolaryngology patients and their families. Purpose The purpose of this specialty-specific guideline is to identify quality improvement opportunities in postoperative pain management of common otolaryngologic surgical procedures. These opportunities are communicated through clear actionable statements with explanation of the support in the literature, evaluation of the quality of the evidence, and recommendations on implementation. Employing these action statements should reduce the variation in care across the specialty and improve postoperative pain control while reducing risk of OUD. The target patients for the guideline are any patients treated for anticipated or reported pain within the first 30 days after undergoing common otolaryngologic procedures. The target audience of the guideline is otolaryngologists who perform surgery and clinicians who manage pain after surgical procedures. Outcomes to be considered include whether the patient has stopped using opioids, has disposed of unused opioids, and was satisfied with the pain management plan. The guideline addresses assessment of the patient for OUD risk factors, counseling on pain expectations, and identifying factors that can affect pain duration and/or severity. It also discusses the use of multimodal analgesia as first-line treatment and the responsible use of opioids. Last, safe disposal of unused opioids is discussed. This guideline is intended to focus on evidence-based quality improvement opportunities judged most important by the guideline development group. It is not a comprehensive guide on pain management in otolaryngologic procedures. The statements in this guideline are not intended to limit or restrict care provided by clinicians based on their experiences and assessments of individual patients. Action Statements The guideline development group made strong recommendations for the following key action statements: (3A) prior to surgery, clinicians should identify risk factors for opioid use disorder when analgesia using opioids is anticipated; (6) clinicians should advocate for nonopioid medications as first-line management of pain after otolaryngologic surgery; (9) clinicians should recommend that patients (or their caregivers) store prescribed opioids securely and dispose of unused opioids through take-back programs or another accepted method. The guideline development group made recommendations for the following key action statements: (1) prior to surgery, clinicians should advise patients and others involved in the postoperative care about the expected duration and severity of pain; (2) prior to surgery, clinicians should gather information specific to the patient that modifies severity and/or duration of pain; (3B) in patients at risk for OUD, clinicians should evaluate the need to modify the analgesia plan; (4) clinicians should promote shared decision making by informing patients of the benefits and risks of postoperative pain treatments that include nonopioid analgesics, opioid analgesics, and nonpharmacologic interventions; (5) clinicians should develop a multimodal treatment plan for managing postoperative pain; (7) when treating postoperative pain with opioids, clinicians should limit therapy to the lowest effective dose and the shortest duration; (8A) clinicians should instruct patients and caregivers how to communicate if pain is not controlled or if medication side effects occur; (8B) clinicians should educate patients to stop opioids when pain is controlled with nonopioids and stop all analgesics when pain has resolved; (10) clinicians should inquire, within 30 days of surgery, whether the patient has stopped using opioids, has disposed of unused opioids, and was satisfied with the pain management plan.

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“…Second, claims for opioid prescriptions filled at outpatient pharmacies were used to proxy prescriber behavior. This proxy underestimates opioid prescriptions; one prior study showed that 15% of patients who received an opioid prescription did not fill it 33 . As the study included only privately insured children, results may not generalize to publicly insured children.…”

Section: Discussionmentioning

confidence: 96%

Opioid Prescribing Patterns Following Pediatric Tonsillectomy in the United States, 2009–2017

et al. 2020

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Objectives Assess national trends in opioid prescription following pediatric tonsillectomy: 1) overall percentage receiving opioids and mean quantity, 2) changes during 2009–2017, and 3) determinants of prescription patterns. Methods Cross‐sectional analysis using 2009–2017 Optum claims data to identify opioid‐naïve children aged 1–18 with claims codes for tonsillectomy (n = 82,842). Quantities of opioids filled in outpatient pharmacies during the perioperative period were extracted and converted into milligram morphine equivalents (MMEs) for statistical comparison. Demographic, clinical, and socioeconomic predictors of opioid fill rate and quantity were determined using regression analyses. Results In 2009, 83.3% of children received opioids, decreasing to 58.3% by 2017. Rates of all‐cause readmissions and post‐tonsillectomy hemorrhages were similar over time. Mean quantity received was 153.47MME (95% confidence intervals [95%CI]: 151.19, 155.76) and did not significantly change during 2009–2017. Opioids were more likely in older children and those with higher household income, but less likely in children with obstructive sleep apnea, other comorbidities, and Hispanic race. Higher quantities of opioids were more likely in older children, while lower quantities were associated with female sex, Hispanic race, and higher household income. Outpatient steroids were prescribed to 8.04% of patients, who were less likely to receive opioids. Conclusion While the percentage of children receiving post‐tonsillectomy opioids decreased during 2009–2017, prescribed quantities remain high and have not decreased over time. Prescription practices were also influenced by clinical and sociodemographic factors. These results highlight the need for guidance, particularly with regard to opioid quantity, in children after tonsillectomy. Level of Evidence N/A Laryngoscope, 131:E1722–E1729, 2021

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A Prospective Evaluation of Postoperative Opioid Use in Otologic Surgery

Abstract: Objective: To prospectively evaluate opioid consumption following adult outpatient otologic surgery.

Cited by 21 publications

References 15 publications

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

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

Clinical Practice Guideline: Opioid Prescribing for Analgesia After Common Otolaryngology Operations

Opioid Prescribing Patterns Following Pediatric Tonsillectomy in the United States, 2009–2017

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