Survey Highlights Need for Opioid Prescription Guidelines in Otolaryngology Residency Programs, Continuing Medical Education

by Linda Kossoff •

What are the findings of an educational investigation of postoperative opioid prescribing patterns among otolaryngological residents and attending physicians?

BOTTOM LINE

Improvement in opioid prescribing and pain management should be an essential component of otolaryngology residency education and attending continuing medical education.

BACKGROUND: Despite the ongoing opioid epidemic in the U.S., studies have demonstrated that opioids are overprescribed postoperatively, leading to mishandling and overuse. Lack of postoperative opioid prescribing guidelines has translated to a large variation in prescribing patterns. Moreover, instruction in this area has historically been overlooked within resident education.

Comment: In light of the recent American Academy of Otolaryngology–Head and Neck Surgery Foundation guideline on opioid prescribing, this is an interesting article within a single institution that seeks to understand postoperative opioid prescribing among both residents and attending physicians. The largest volume of postoperative opioids for both groups was prescribed following tonsillectomy, which lines up with the guideline in which the most common procedure associated with a high amount of pain in otolaryngology is tonsillectomy in adults. Efforts to obtain baseline information on local practice patterns can help guide improvement efforts to reduce opioid prescribing in the future. —Sarah Bowe, MD

STUDY DESIGN: Cross-sectional survey study.

SETTING: Department of Otolaryngology–Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston.

SYNOPSIS: Researchers queried residents and attending clinical faculty members via electronic survey at a single academic institution from February through April 2020 regarding their opioid prescribing practices. Twenty-nine attending otolaryngologists and 22 residents completed the survey. Opioid prescriptions were categorized on an integer scale from 0 to 50 pills, with each pill equivalent to 5 mg of oxycodone. Among faculty, surgical cases with the most postoperatively prescribed opioids included tonsillectomy, neck dissection, brow lift, facelift, and open reduction of facial trauma. Among residents, surgical cases with the most postoperatively prescribed opioids included tonsillectomy (ages 11 years and above), neck dissection, open reduction of facial trauma, parotidectomy, and thyroid/parathyroid surgery. Residents on average prescribed fewer opioid pills per procedure than attendings. However, in general, there was agreement in opioid prescribing patterns between residents and attending physicians, suggesting that residents model attendings’ opioid prescription patterns. Authors emphasized the need for institutional and society guidelines on postoperative pain management within otolaryngology. Study limitations included the single institution cross-sectional survey study design and the broad classification of opioid prescribing.

CITATION: Mokhtari TE, Miller LE, Chen JX, et al. Opioid prescribing practices in academic otolaryngology: A single institutional survey. Am J Otolaryngol. 2021;42:103038.