Incidence and Predictive Factors for Additional Opioid Prescription after Endoscopic Skull Base Surgery

Abstract

Introduction Postoperative pain management and opioid use following endoscopic skull base surgery (ESBS) is not well understood. A subset of patients requires additional opioid prescription (AOP) in the postoperative period. The objective of this study is to describe the incidence of AOP, as well as evaluate patient and surgical characteristics that may predict additional pain management requirements following ESBS. Methods A retrospective review of cases undergoing ESBS between November 2016 and August 2018 was performed. We reviewed patients' sociodemographic and clinical data, and Controlled Substance Utilization Review and Evaluation System (CURES) records. Stepwise multivariable logistic regressions were performed to evaluate the factors associated with AOP within 60 days following surgery. Results A total of 42 patients were identified. Indications for ESBS included intracranial mass (64.2%), sinonasal malignancy (23.8%), and skull base reconstruction (9.5%). AOP were recorded in nine patients (21.4%). There were no significant differences in operative factors, including approach, lesion location, or perioperative analgesia between the two cohorts. On multivariable logistic regression, we found that younger age (odds ratio [OR]: 0.891, 95% confidence interval [CI]: 0.79–1.00, p = 0.050), comorbid depression (OR: 86.48, 95% CI: 1.40–5,379.07, p = 0.034), and preoperative opioid use (OR: 104.45, 95% CI: 1.41–7,751.10, p = 0.034) were associated with additional prescriptions postoperatively. Conclusion The requirement for extended postoperative opioid pain control is common after ESBS. Patient demographics including age and psychosocial factors, such as depression may predict the need for AOP after ESBS. These results suggest that patient-driven factors, rather than surgical characteristics, may determine the need for prolonged pain control requirements after ESBS.

Opioid Prescribing Patterns After Skull Base Surgery for Vestibular Schwannoma

“…However, few studies to date have a sample size large enough to study opioid prescribing patterns specifically in patients undergoing skull base surgery for VS. Boyd et al conducted a prospective observational study in patients undergoing otologic and neurotologic surgeries over a 6-month period and found that the majority of pain pills went unused (20); however, only eight patients in the study underwent lateral skull base surgery and the specific procedures were not specified. A recent series of 42 patients undergoing endoscopic anterior skull base surgery found 21.4% required additional prescription, and patient-level factors such as younger age, comorbid depression, and preoperative opioid use increased the odds of requiring additional opioids postoperatively (21). Nonetheless, despite the growing interest in improving the quality of life of patients with VS undergoing surgery, few recent studies have focused on their postoperative opioid requirements.…”

Predictive Factors for Postoperative Opioid Use in Elective Endoscopic Endonasal Skull Base Surgery

“…This finding is supported by Rimmer et al, in which patients with preexisting anxiety or depression had higher average inpatient postoperative opioid use after EESBS 13 . In the postoperative outpatient setting, patients with anxiety or depression who underwent EESBS required additional opioid prescriptions than those without mental illness 12 . The presence of mood and anxiety disorders have also been predictors of increased postoperative pain across other surgical specialties 20–22 …”

“…13 In the postoperative outpatient setting, patients with anxiety or depression who underwent EESBS required additional opioid prescriptions than those without mental illness. 12 The presence of mood and anxiety disorders have also been predictors of increased postoperative pain across other surgical specialties. [20][21][22] Identifying anxiety or depression as a predictor of postoperative pain calls for perioperative mental health optimization, such as the use of preoperative screening, education, and targeted mental health therapy to reduce postoperative opioid use.…”

“…Nonetheless, pain may persist for patients who undergo endoscopic endonasal skull base surgery (EESBS). Thus, postoperative pain in EESBS and its associated factors have been a focus of recent investigations 11,12 . The purpose of this study is to identify demographic and surgical factors associated with increased postoperative opioid use in patients who undergo EESBS.…”