Factors Associated with Increased Opioid Use in Endoscopic Sinus Surgery

Which clinical factors affect opioid usage following functional endoscopic sinus surgery (FESS)?

Bottom Line
Concurrent septoplasty and younger age were associated with increased opioid usage, although the majority of FESS patients did not take more than five opioid tablets after surgery.

Background: FESS is one of the most common otolaryngologic procedures, considered the gold standard for chronic rhinosinusitis (CRS) surgical treatment. With the wide variation in opioid prescribing practices after FESS, there is a need for a better understanding of patient opioid usage and the clinical and demographic factors that can influence opioid intake.

Study design: Retrospective medical records study of 136 subjects undergoing FESS by the senior author between September 2016 and December 2017.

Setting: Division of Head and Neck Surgery and Communication Sciences, Department of Surgery, Duke University, Durham, North Carolina.

Synopsis: Patients were stratified into three groups based on number of opioid tablets taken during the first week after surgery. Of the 136 patients, 31 reported taking no opioid medications, 61 reported taking one to five tablets, and 44 reported taking more than five tablets. The median age among groups varied significantly, with a higher proportion of older patients in the group reporting no opioid use compared with the other groups. Patients who underwent bilateral FESS were significantly more likely to take more than five opioid tablets than those who underwent unilateral FESS. Patients with concurrent septoplasty were disproportionately higher in the more than five tablets group: The odds of taking more than five tablets were approximately five times greater than those taking none, after controlling for age. For every unit increase in age, the odds of a patient taking more than five tablets were significantly lower compared to those taking no pain tablets after controlling for whether septoplasty was performed. Limitations included artificially stratified categories for opioid use, a potential for recall bias, and the impact of variations in surgical technique.

Citation: Raikundalia MD, Cheng TZ, Truong T, et al. Factors associated with opioid use after endoscopic sinus surgery. Laryngoscope. 2019;129:1751–1755.