Peri-Operative Pain and Opioid Use in Opioid-Naïve Patients Following Inpatient Head and Neck Surgery
Pain management is an important consideration for Head and Neck Cancer (HNC) patients as they are at an increased risk of developing chronic opioid use, which can negatively impact both quality of life and survival outcomes. This retrospective cohort study aimed to evaluate pain, opioid use and opio...
| Main Authors: | , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2022-07-01
|
| Series: | Frontiers in Psychiatry |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fpsyt.2022.857083/full |
| _version_ | 1818535823883108352 |
|---|---|
| author | Danielle R. Trakimas Carlos Perez-Heydrich Rajarsi Mandal Marietta Tan Christine G. Gourin Carole Fakhry Wayne M. Koch Jonathon O. Russell Ralph P. Tufano David W. Eisele Peter S. Vosler |
| author_facet | Danielle R. Trakimas Carlos Perez-Heydrich Rajarsi Mandal Marietta Tan Christine G. Gourin Carole Fakhry Wayne M. Koch Jonathon O. Russell Ralph P. Tufano David W. Eisele Peter S. Vosler |
| author_sort | Danielle R. Trakimas |
| collection | DOAJ |
| description | Pain management is an important consideration for Head and Neck Cancer (HNC) patients as they are at an increased risk of developing chronic opioid use, which can negatively impact both quality of life and survival outcomes. This retrospective cohort study aimed to evaluate pain, opioid use and opioid prescriptions following HNC surgery. Participants included patients undergoing resection of a head and neck tumor from 2019–2020 at a single academic center with a length of admission (LOA) of at least 24 h. Exclusion criteria were a history of chronic pain, substance-use disorder, inability to tolerate multimodal analgesia or a significant post-operative complication. Subjects were compared by primary surgical site: Neck (neck dissection, thyroidectomy or parotidectomy), Mucosal (resection of tumor of upper aerodigestive tract, excluding oropharynx), Oropharyngeal (OP) and Free flap (FF). Average daily pain and total daily opioid consumption (as morphine milligram equivalents, MME) and quantity of opioids prescribed at discharge were compared. A total of 216 patients met criteria. Pain severity and daily opioid consumption were comparable across groups on post-operative day 1, but both metrics were significantly greater in the OP group on the day prior to discharge (DpDC) (5.6 (1.9–8.6), p < 0.05; 49 ± 44 MME/day, p < 0.01). The quantity of opioids prescribed at discharge was associated with opioid consumption on the DpDC only in the Mucosal and FF groups, which had longer LOA (6–7 days) than the Neck and OP groups (1 day, p < 0.001). Overall, 65% of patients required at least one dose of an opioid on the DpDC, yet 76% of patients received a prescription for an opioid medication at discharge. A longer LOA (aOR = 0.82, 95% CI: 0.63–0.98) and higher Charlson Comorbidity Index (aOR = 0.08, 95% CI: 0.01–0.48) were negatively associated with receiving an opioid prescription at the time of discharge despite no opioid use on the DpDC, respectively. HNC patients, particularly those with shorter LOA, may be prescribed opioids in excess of their post-operative needs, highlighting the need the for improved pain management algorithms in this patient population. Future work aims to use prospective surveys to better define post-operative and outpatient pain and opioid requirements following HNC surgery. |
| first_indexed | 2024-12-11T18:30:04Z |
| format | Article |
| id | doaj.art-dd1c5498a1084dcd83a426276a71a5f8 |
| institution | Directory Open Access Journal |
| issn | 1664-0640 |
| language | English |
| last_indexed | 2024-12-11T18:30:04Z |
| publishDate | 2022-07-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Psychiatry |
| spelling | doaj.art-dd1c5498a1084dcd83a426276a71a5f82022-12-22T00:54:57ZengFrontiers Media S.A.Frontiers in Psychiatry1664-06402022-07-011310.3389/fpsyt.2022.857083857083Peri-Operative Pain and Opioid Use in Opioid-Naïve Patients Following Inpatient Head and Neck SurgeryDanielle R. TrakimasCarlos Perez-HeydrichRajarsi MandalMarietta TanChristine G. GourinCarole FakhryWayne M. KochJonathon O. RussellRalph P. TufanoDavid W. EiselePeter S. VoslerPain management is an important consideration for Head and Neck Cancer (HNC) patients as they are at an increased risk of developing chronic opioid use, which can negatively impact both quality of life and survival outcomes. This retrospective cohort study aimed to evaluate pain, opioid use and opioid prescriptions following HNC surgery. Participants included patients undergoing resection of a head and neck tumor from 2019–2020 at a single academic center with a length of admission (LOA) of at least 24 h. Exclusion criteria were a history of chronic pain, substance-use disorder, inability to tolerate multimodal analgesia or a significant post-operative complication. Subjects were compared by primary surgical site: Neck (neck dissection, thyroidectomy or parotidectomy), Mucosal (resection of tumor of upper aerodigestive tract, excluding oropharynx), Oropharyngeal (OP) and Free flap (FF). Average daily pain and total daily opioid consumption (as morphine milligram equivalents, MME) and quantity of opioids prescribed at discharge were compared. A total of 216 patients met criteria. Pain severity and daily opioid consumption were comparable across groups on post-operative day 1, but both metrics were significantly greater in the OP group on the day prior to discharge (DpDC) (5.6 (1.9–8.6), p < 0.05; 49 ± 44 MME/day, p < 0.01). The quantity of opioids prescribed at discharge was associated with opioid consumption on the DpDC only in the Mucosal and FF groups, which had longer LOA (6–7 days) than the Neck and OP groups (1 day, p < 0.001). Overall, 65% of patients required at least one dose of an opioid on the DpDC, yet 76% of patients received a prescription for an opioid medication at discharge. A longer LOA (aOR = 0.82, 95% CI: 0.63–0.98) and higher Charlson Comorbidity Index (aOR = 0.08, 95% CI: 0.01–0.48) were negatively associated with receiving an opioid prescription at the time of discharge despite no opioid use on the DpDC, respectively. HNC patients, particularly those with shorter LOA, may be prescribed opioids in excess of their post-operative needs, highlighting the need the for improved pain management algorithms in this patient population. Future work aims to use prospective surveys to better define post-operative and outpatient pain and opioid requirements following HNC surgery.https://www.frontiersin.org/articles/10.3389/fpsyt.2022.857083/fullhead and neck surgerypost-operative analgesiaopioidsprescriptionspain |
| spellingShingle | Danielle R. Trakimas Carlos Perez-Heydrich Rajarsi Mandal Marietta Tan Christine G. Gourin Carole Fakhry Wayne M. Koch Jonathon O. Russell Ralph P. Tufano David W. Eisele Peter S. Vosler Peri-Operative Pain and Opioid Use in Opioid-Naïve Patients Following Inpatient Head and Neck Surgery Frontiers in Psychiatry head and neck surgery post-operative analgesia opioids prescriptions pain |
| title | Peri-Operative Pain and Opioid Use in Opioid-Naïve Patients Following Inpatient Head and Neck Surgery |
| title_full | Peri-Operative Pain and Opioid Use in Opioid-Naïve Patients Following Inpatient Head and Neck Surgery |
| title_fullStr | Peri-Operative Pain and Opioid Use in Opioid-Naïve Patients Following Inpatient Head and Neck Surgery |
| title_full_unstemmed | Peri-Operative Pain and Opioid Use in Opioid-Naïve Patients Following Inpatient Head and Neck Surgery |
| title_short | Peri-Operative Pain and Opioid Use in Opioid-Naïve Patients Following Inpatient Head and Neck Surgery |
| title_sort | peri operative pain and opioid use in opioid naive patients following inpatient head and neck surgery |
| topic | head and neck surgery post-operative analgesia opioids prescriptions pain |
| url | https://www.frontiersin.org/articles/10.3389/fpsyt.2022.857083/full |
| work_keys_str_mv | AT daniellertrakimas perioperativepainandopioiduseinopioidnaivepatientsfollowinginpatientheadandnecksurgery AT carlosperezheydrich perioperativepainandopioiduseinopioidnaivepatientsfollowinginpatientheadandnecksurgery AT rajarsimandal perioperativepainandopioiduseinopioidnaivepatientsfollowinginpatientheadandnecksurgery AT mariettatan perioperativepainandopioiduseinopioidnaivepatientsfollowinginpatientheadandnecksurgery AT christineggourin perioperativepainandopioiduseinopioidnaivepatientsfollowinginpatientheadandnecksurgery AT carolefakhry perioperativepainandopioiduseinopioidnaivepatientsfollowinginpatientheadandnecksurgery AT waynemkoch perioperativepainandopioiduseinopioidnaivepatientsfollowinginpatientheadandnecksurgery AT jonathonorussell perioperativepainandopioiduseinopioidnaivepatientsfollowinginpatientheadandnecksurgery AT ralphptufano perioperativepainandopioiduseinopioidnaivepatientsfollowinginpatientheadandnecksurgery AT davidweisele perioperativepainandopioiduseinopioidnaivepatientsfollowinginpatientheadandnecksurgery AT petersvosler perioperativepainandopioiduseinopioidnaivepatientsfollowinginpatientheadandnecksurgery |