Postoperative opioid‐prescribing practices in otolaryngology: Evidence‐based guideline outcomes
Abstract Objectives We previously reported that >50% of postoperative opioids prescribed at our institution went unused for common otolaryngologic procedures. Based on these findings, we instituted multimodal, evidence‐based guidelines for postoperative pain management. In the second part of our...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2023-02-01
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| Series: | Laryngoscope Investigative Otolaryngology |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/lio2.990 |
| _version_ | 1797895934606049280 |
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| author | Tanvi Rana Kelly Daniels Sophia Dang Jonathan C. Li Cecilia G. Freeman Alexander Duffy Joseph Curry Adam Luginbuhl Elizabeth Cottrill David Cognetti |
| author_facet | Tanvi Rana Kelly Daniels Sophia Dang Jonathan C. Li Cecilia G. Freeman Alexander Duffy Joseph Curry Adam Luginbuhl Elizabeth Cottrill David Cognetti |
| author_sort | Tanvi Rana |
| collection | DOAJ |
| description | Abstract Objectives We previously reported that >50% of postoperative opioids prescribed at our institution went unused for common otolaryngologic procedures. Based on these findings, we instituted multimodal, evidence‐based guidelines for postoperative pain management. In the second part of our multiphasic study, we evaluated the effects of these guidelines on (1) quantity of unused opioids, (2) patient satisfaction, and (3) institutional perceptions toward the opioid epidemic and prescribing guidelines. Methods Standardized, procedure‐specific opioid prescription guidelines were created using prospective data from the first phase of our study and evidence from current literature. Again, we examined sialendoscopy, parotidectomy, parathyroidectomy/thyroidectomy, and transoral robotic surgery (TORS). Patients were surveyed at their first postoperative appointment. Groups from Phases I and II were compared. Attending physicians were surveyed before the start of the multiphasic project and after prescribing guidelines were implemented. Results Prescribing guidelines led to an average reduction in prescribed morphine milligram equivalents (MME) per patient by: 48% (sialendoscopy), 63% (parotidectomy), 60% (para/thyroidectomy), and 42% (TORS). Average used MME per patient for parotidectomy was significantly reduced (64%). The proportion of unused MME per patient and patient satisfaction scores did not significantly change after guidelines were implemented. Conclusion Implementation of opioid‐prescribing guidelines and the use of multimodal analgesia substantially reduced the amount of opioids prescribed across all procedures without impacting patient satisfaction. Level of Evidence 2 |
| first_indexed | 2024-04-10T07:33:37Z |
| format | Article |
| id | doaj.art-cf3257387c554eb5b353488a1e7bf063 |
| institution | Directory Open Access Journal |
| issn | 2378-8038 |
| language | English |
| last_indexed | 2024-04-10T07:33:37Z |
| publishDate | 2023-02-01 |
| publisher | Wiley |
| record_format | Article |
| series | Laryngoscope Investigative Otolaryngology |
| spelling | doaj.art-cf3257387c554eb5b353488a1e7bf0632023-02-23T13:23:03ZengWileyLaryngoscope Investigative Otolaryngology2378-80382023-02-018131332110.1002/lio2.990Postoperative opioid‐prescribing practices in otolaryngology: Evidence‐based guideline outcomesTanvi Rana0Kelly Daniels1Sophia Dang2Jonathan C. Li3Cecilia G. Freeman4Alexander Duffy5Joseph Curry6Adam Luginbuhl7Elizabeth Cottrill8David Cognetti9Sidney Kimmel Medical College at Thomas Jefferson University Philadelphia Pennsylvania USASidney Kimmel Medical College at Thomas Jefferson University Philadelphia Pennsylvania USASidney Kimmel Medical College at Thomas Jefferson University Philadelphia Pennsylvania USASidney Kimmel Medical College at Thomas Jefferson University Philadelphia Pennsylvania USASidney Kimmel Medical College at Thomas Jefferson University Philadelphia Pennsylvania USADepartment of Otolaryngology–Head and Neck Surgery Thomas Jefferson University Philadelphia Pennsylvania USADepartment of Otolaryngology–Head and Neck Surgery Thomas Jefferson University Philadelphia Pennsylvania USADepartment of Otolaryngology–Head and Neck Surgery Thomas Jefferson University Philadelphia Pennsylvania USADepartment of Otolaryngology–Head and Neck Surgery Thomas Jefferson University Philadelphia Pennsylvania USADepartment of Otolaryngology–Head and Neck Surgery Thomas Jefferson University Philadelphia Pennsylvania USAAbstract Objectives We previously reported that >50% of postoperative opioids prescribed at our institution went unused for common otolaryngologic procedures. Based on these findings, we instituted multimodal, evidence‐based guidelines for postoperative pain management. In the second part of our multiphasic study, we evaluated the effects of these guidelines on (1) quantity of unused opioids, (2) patient satisfaction, and (3) institutional perceptions toward the opioid epidemic and prescribing guidelines. Methods Standardized, procedure‐specific opioid prescription guidelines were created using prospective data from the first phase of our study and evidence from current literature. Again, we examined sialendoscopy, parotidectomy, parathyroidectomy/thyroidectomy, and transoral robotic surgery (TORS). Patients were surveyed at their first postoperative appointment. Groups from Phases I and II were compared. Attending physicians were surveyed before the start of the multiphasic project and after prescribing guidelines were implemented. Results Prescribing guidelines led to an average reduction in prescribed morphine milligram equivalents (MME) per patient by: 48% (sialendoscopy), 63% (parotidectomy), 60% (para/thyroidectomy), and 42% (TORS). Average used MME per patient for parotidectomy was significantly reduced (64%). The proportion of unused MME per patient and patient satisfaction scores did not significantly change after guidelines were implemented. Conclusion Implementation of opioid‐prescribing guidelines and the use of multimodal analgesia substantially reduced the amount of opioids prescribed across all procedures without impacting patient satisfaction. Level of Evidence 2https://doi.org/10.1002/lio2.990evidence‐based guidelineshead and neckmultimodal analgesiaotolaryngologypain managementpara |
| spellingShingle | Tanvi Rana Kelly Daniels Sophia Dang Jonathan C. Li Cecilia G. Freeman Alexander Duffy Joseph Curry Adam Luginbuhl Elizabeth Cottrill David Cognetti Postoperative opioid‐prescribing practices in otolaryngology: Evidence‐based guideline outcomes Laryngoscope Investigative Otolaryngology evidence‐based guidelines head and neck multimodal analgesia otolaryngology pain management para |
| title | Postoperative opioid‐prescribing practices in otolaryngology: Evidence‐based guideline outcomes |
| title_full | Postoperative opioid‐prescribing practices in otolaryngology: Evidence‐based guideline outcomes |
| title_fullStr | Postoperative opioid‐prescribing practices in otolaryngology: Evidence‐based guideline outcomes |
| title_full_unstemmed | Postoperative opioid‐prescribing practices in otolaryngology: Evidence‐based guideline outcomes |
| title_short | Postoperative opioid‐prescribing practices in otolaryngology: Evidence‐based guideline outcomes |
| title_sort | postoperative opioid prescribing practices in otolaryngology evidence based guideline outcomes |
| topic | evidence‐based guidelines head and neck multimodal analgesia otolaryngology pain management para |
| url | https://doi.org/10.1002/lio2.990 |
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