Opioid prescribing patterns among otolaryngologists: Crucial insights among the medicare population

Svider, Peter F.; Arianpour, Khashayar; Guo, Eric W.; Folbe, Elana; Zuliani, Giancarlo; Lin, Ho‐Sheng; Eloy, Jean Anderson; Folbe, Adam J.

doi:10.1002/lary.27101

Cited by 56 publications

(62 citation statements)

References 20 publications

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Section: Discussionmentioning

confidence: 99%

“…Recently, large cohort analyses of the opioid prescribing patterns of otolaryngologists using Medicare Part D beneficiary data were performed. Significant geographic variation was identified, 13,14 as well as fewer opioids prescribed after sinus surgery by otolaryngologists with either less experience (<10 years) or fellowship training. 13 We identified several factors associated with increased quantity of opioid tablets prescribed, including concurrent rhinoplasty, placement of nasal splints, septoplasty, and frontal sinus drillout, all of which may be associated with increased pain.…”

Section: Discussionmentioning

confidence: 99%

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Opioid prescription patterns and use among patients undergoing endoscopic sinus surgery

et al. 2018

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Objectives/Hypothesis Opioid‐related deaths in the United States have increased 200% since 2000, in part due to prescription diversion from patients who had a surgical procedure. The purpose of this study was to characterize provider prescription patterns and assess patient‐reported opioid use after endoscopic sinus surgery (ESS). Study Design Retrospective chart review. Methods Patients who underwent ESS between May 2017 and May 2018 were included. Opioid prescription, operative details, and postoperative opioid use data were extracted. The Massachusetts Prescription Awareness Tool (MassPAT) was queried to determine if patients filled their prescription. Results One hundred fifty‐five patients were included. Nearly all patients received an opioid prescription (94.8%). An average of 15.6 tablets was prescribed per patient. Among 116 patients with MassPAT data, 91.4% filled their prescription. Among 67 patients who reported the number of tablets they had used at the time of first follow‐up appointment, 73.1% reported taking no opioids. Mean number of tablets prescribed was significantly greater among patients who underwent primary versus revision surgery (16.5 vs. 13.5, P = .0111) and those who had splints placed (21.5 vs. 15.1, P = .0037). Predictors of opioid use included concurrent turbinate reduction (58.3% vs. 14.3%, P < .0001) and concurrent septoplasty (45.5% vs. 21.6%, P = .039). Conclusions Nearly all patients who underwent ESS were prescribed an opioid, and nearly all patients filled their prescription. However, the vast majority of patients did not require any opioid medication for postoperative pain control. As the opioid epidemic continues to persist, these findings have immediate relevance to current prescribing patterns and pain management practices. Level of Evidence 4 Laryngoscope, 129:1046–1052, 2019

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Opioid prescription patterns and use among patients undergoing endoscopic sinus surgery

et al. 2018

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“…In response to this, many surgical subspecialties have tried to standardize prescribing practices and develop perioperative protocols for routine surgical procedures to guide prescribers. Otolaryngology has been no exception, and a quick review of the literature can find a number of articles reporting prescribing practices, alternate nonopioid regimens, and surveys of prescribers in all age groups and subspecialties . Despite this, there is no consensus on postoperative pain management for routine otolaryngology procedures.…”

Section: Introductionmentioning

confidence: 99%

Impact of perioperative pain management protocol on opioid prescribing patterns

et al. 2019

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Objectives/Hypothesis: The objective of this study was to demonstrate the impact of preoperative education, patient risk stratification, and a postoperative pain management protocol for common head and neck procedures on opioid prescribing patterns and postoperative pain reporting.Study Design: Retrospective cohort study. Methods: A postoperative pain management protocol was developed and implemented for patients undergoing head and neck surgical procedures. Medical charts were queried and postoperative patient satisfaction surveys were administered. Opioid prescribing patterns were evaluated in cohorts of patients undergoing procedures with anticipated mild pain (e.g., thyroidectomy, parotidectomy, lymph node biopsy) before and after the implementation of the protocol. Postoperative patient surveys were analyzed in the postimplementation group.Results: A total of 302 patients were included for analysis. One hundred fifty-four patients and 148 patients underwent surgery before and after the implementation of the protocol, respectively. There was a decreased incidence of oxycodonecontaining prescriptions (83% to 26%), and tramadol became the most common discharge medication (70%). There was a significant decrease in the total number of pills prescribed after the implementation of the protocol (34.71 to 25.36, P < .001). Ninety percent of patients reported high satisfaction (≥8) with pain management.Conclusions: This study shows that a comprehensive pain management protocol can significantly reduce the amount and potency of opioid pain medication prescribed after head and neck procedures while maintaining high patient satisfaction.

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“…Surgeons are responsible for a significant proportion of dispensed opioid prescriptions, second only to pain medicine specialists . In 2015, approximately 9000 otolaryngologists were responsible for over 130,000 opioid prescriptions among the Medicare population alone . Among sinus surgeons, a majority of providers prescribed greater than 25 prescriptions annually, often for longer than 5 days .…”

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confidence: 99%

Opioid analgesic use and patient‐reported pain outcomes after rhinologic surgery

Riley

Kim

Sclafani

et al. 2018

Int Forum Allergy Rhinol

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Background: Opioid-based analgesics are routinely prescribed a er elective rhinologic surgery. Balancing appropriate pain management while avoiding overprescription necessitates an evidence-based approach.Methods: Patients undergoing elective rhinologic surgery, including endoscopic sinus surgery (ESS), septoplasty, or ESS with septoplasty, were prospectively enrolled. Patients completed demographic and psychometric questionnaires assessing a itudes toward pain, baseline anxiety, and depression before surgery. Postoperatively, patients documented peak pain levels (0-100 visual analog scale) and daily prescription and nonprescription medication requirements over a 2-week period. Results:Of the 42 patients enrolled, 15 underwent ESS, 14 septoplasty, and 13 ESS with septoplasty. Five patients (11.9%) reported a history of chronic pain before surgery. Patients were given a median of 30 opioid pain pills a er surgery: acetaminophen with codeine 325/30 mg (10 patients) or oxycodone with acetaminophen 5/325 mg (32 patients). Patients had a median of 27 pills le over at the end of the study period. Median peak pain levels for all procedures were 22 (range, 0-94) on day 0, 26.5 (range, 0-86) on day 1, 8.5 (range, 0-85) on day 3, and 3 (range, 0-52) on day 7. Median opioid requirements measured in morphine milligram equivalents (MME) over those same days were 6.0, 4.1, 0, and 0, respectively. Conclusion:Postoperative pain a er elective rhinologic surgery appears to peak over the first 3 days and decreases rapidly a erward. Most patients require a few doses of opioid analgesics. Opioid requirements and pain levels did not vary based on surgeon, type and extent of surgery, and demographic factors. Judicious prescribing of opioid medication a er rhinologic surgery represents a practical opportunity for rhinologists and otolaryngologists to reduce opioid overprescription and abuse. C 2018 ARS-AAOA, LLC. How to Cite thisArticle: Riley CA, Kim M, Sclafani AP, et al. Opioid analgesic use and patient-reported pain outcomes a er rhinologic surgery. Int Forum Allergy Rhinol. 2019;9:339-344.

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Opioid prescribing patterns among otolaryngologists: Crucial insights among the medicare population

Abstract: NA. Laryngoscope, 128:1576-1581, 2018.

Cited by 56 publications

References 20 publications

Opioid prescription patterns and use among patients undergoing endoscopic sinus surgery

Opioid prescription patterns and use among patients undergoing endoscopic sinus surgery

Impact of perioperative pain management protocol on opioid prescribing patterns

Opioid analgesic use and patient‐reported pain outcomes after rhinologic surgery

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