Factors associated with opioid use after endoscopic sinus surgery

Abstract

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

Prescription patterns and opioid usage in sinonasal surgery

“…Similar to other recent studies, our patients who underwent ESS had increased opioid consumption when a concurrent septoplasty and/or turbinoplasty was performed, and, comparable to work by Riley et al and Raikundalia et al, the extent of ESS (full vs limited) did not significantly influence pain control or opioid use . Although there are mixed results on the influence of age on opioid usage, our results are similar to others showing that younger patients require slightly more . However, as in our study with a very mild negative correlation with increasing age and other studies showing no correlation between age and opioid use, the clinical significance of this is not likely drastic .…”

“…Nevertheless, there is much to gain by looking at the similarities and differences in those studies. Similar to other recent studies, our patients who underwent ESS had increased opioid consumption when a concurrent septoplasty and/or turbinoplasty was performed, and, comparable to work by Riley et al and Raikundalia et al, the extent of ESS (full vs limited) did not significantly influence pain control or opioid use . Although there are mixed results on the influence of age on opioid usage, our results are similar to others showing that younger patients require slightly more .…”

“…12,[22][23][24] Although there are mixed results on the influence of age on opioid usage, our results are similar to others showing that younger patients require slightly more. 12,22,23 However, as in our study with a very mild negative correlation with increasing age and other studies showing no correlation between age and opioid use, the clinical significance of this is not likely drastic. 7,12,22,24 Furthermore, although Jafari et al showed that preoperative opioid use was associated with additional opioid use, our study and multiple others showed that chronic pain patients will not require a significant amount more than other patients.…”

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

“…Other surgical factors, including revision status and concomitant septoplasty, turbinoplasty, or dacryocystorhinostomy, did not significantly affect opioid requirements. These results contrast with those of Raikundalia et al, which found that patients undergoing septoplasty had higher opioid requirements in the first 1 to 2 weeks following ESS . However, it is possible that the pain and analgesic requirements from septoplasty occur after the first 24 hours following ESS, which would have limited our ability to find this association.…”

“…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 …”