More Than Half of Prescribed Postoperative Opioids Go Unused

by Amy E. Hamaker •

What are opioid prescription and consumption figures, as well as pain trends, for common otolaryngologic procedures?

Bottom Line: More than half of prescribed post-operative opioids went unused, and this was most pronounced for nonmucosal surgeries.

Background: Opioids are preferred for post-operative pain management. They are overprescribed to ensure adequate pain control, but up to 75% remain unused. The CDC recently issued recommendations on procedure-specific opioid-prescribing guidelines, but these guidelines are absent in otolaryngology.

Study design: Survey of 161 patients who underwent otolaryngologic procedures between July 2018 and February 2019.

Setting: Thomas Jefferson University, Philadelphia, Penn.

Synopsis: Overall, patients were prescribed a total of 19,747.5 morphine milligram equivalents (MME). A total of 8,588 MME were reported as used, leaving 11,159 MME unused, equivalent to 1,488 pills of 5 mg oxycodone. Among transoral robotic surgery resection patients, pain peaked on the first post-operative day (POD) and trended downward. On average, patients were prescribed 367.5 MME (49 pills), and consumed 220.6 MME (29 pills). Among sialendoscopy patients, pain trended downward from POD 0. On average, patients were prescribed 88.7 MME (11.8 pills), and consumed 31.0 MME (4.1 pills). Among thyroidectomy/parathyroidectomy patients, pain peaked on POD 1 and trended downward from POD 0. On average, patients were prescribed 105.9 MME (14.1 pills), and consumed 30.3 MME (4.0 pills). Among parotidectomy patients, pain peaked on POD 1 and trended downward. On average, patients were prescribed 118.1 MME (15.7 pills), and consumed 42.8 MME (5.7 pills). Male gender, tobacco use, and psychiatric medications were positive predictors of post-operative opioid use. Limitations included an inherent recall bias, neck dissections that were combined with some procedures, difficulty in quantifying liquid formulations, and potential opioid consumption beyond the first follow-up. 

Citation: Dang S, Duffy A, Li JC, et al. Postoperative opioid-prescribing practices in otolaryngology: a multiphasic study. Laryngoscope. 2020;130:659-665.