Prescription patterns and opioid usage in sinonasal surgery

Abstract

Background Excess opioid use after surgery contributes to opiate misuse and diversion. Understanding opioid prescribing and utilization patterns after sinonasal surgery is critical in designing effective practice protocols. In this study we aim to identify factors associated with variable opioid usage and further delineate optimal prescription patterns for sinonasal surgery. Methods All patients undergoing sinonasal surgery within a single health‐care system from March 2017 to August 2018 were sent electronic postoperative surveys. Data were collected on the amount of opioid required, pain control, presurgical opiate use, and narcotic disposal. Additional data collected from the electronic medical record included demographics, type of surgery performed, and total amount of opioid prescribed, including refills. Results Three‐hundred sixty four patients were included. A mean number of 25.3 tablets were prescribed per patient, yet the mean taken was just 11.8 tablets. Excess opioids were prescribed 84.9% of the time with a mean excess narcotic in oral morphine equivalents of 152.5. Among patients, 11.8% reported using no opioids, whereas 52.1% used <50% and 36.1% used >50% of their narcotic prescription. Patients used 9.3% of their full prescription and only 2.6% required a refill. The amount used was not associated with complexity of endoscopic sinus surgery, type of opiate prescribed, gender, distance living from hospital, or current opioid usage before surgery (p > 0.05). The addition of septoplasty and/or turbinoplasty was associated with variation in opioid usage (p < 0.001). A total of 76.1% of patients incorrectly discarded/stored excess opiates. Conclusion Opioids are overprescribed after sinonasal surgery. The amount of postoperative opiate prescribed should be greatly reduced and may be based on the specific procedures performed. Improved patient education regarding disposal of excess narcotics may help to curtail future opioid diversion.

International consensus statement on allergy and rhinology: rhinosinusitis 2021

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Evaluation of opioid prescription patterns among patients undergoing thyroid surgery

“…Educational materials alone have been proven to be effective in increasing safe opioid storage and disposal 16,17 . Better integration of educational materials during the preoperative visit and the day of surgery could help decrease intentional and unintentional opioid diversion within the community through improved disposal 18 . Ultimately, the Food and Drug Administration recommends disposing of opioids at Drug Enforcement Administration approved sites or approved community take back programs; however, if these are not available, then flushing designated opioids is advised 19 …”

Assessment of narcotic use in management of post‐op pain after functional endoscopic sinus surgery

“…More recently, in a series of 364 patients, Newberry et al found that excess narcotics were prescribed 84.9% of the time. Among patients, 11.8% reported using no narcotics, 52.1% used <50%, and 36.1% used >50% of their narcotic prescription 8 . In the pursuit of finding non‐narcotic alternatives to pain control after sinonasal surgery, Kemppainen et al 9 conducted a clinical trial that concluded acetaminophen alone is a highly effective pain treatment regimen after FESS.…”