Optimizing Opioid-Prescribing Practices After Parathyroidectomy

Alaa Sada, Daniel S. Ubl, Cornelius A. Thiels, Patricia A. Cronin, Benzon M. Dy, Melanie L. Lyden, Geoffrey B. Thompson, Travis J. McKenzie, Elizabeth B Habermann

Research output: Contribution to journalArticle

Abstract

Background: To help control opioid overprescription, we conducted a large institutional, 3-site initiative to provide discharge prescribing guidelines for different procedures. Our aim is to refine institutional guidelines for parathyroidectomy. Methods: Patients undergoing parathyroidectomy completed a 28-question survey about opioid consumption. Discharge opioid prescription amounts were converted into morphine milligram equivalents (MMEs) and reported as median and interquartile range (IQR). Consumption was dichotomized into top quartile MME users (Q4) versus standard users (Q1, Q3). Univariate analysis compared opioid consumption. Results: A total of 91 patients were included; 90% were opioid-naive. While the median prescribed was 75 (IQR 75, 150) MME, the median consumed was 0 (IQR 0, 20). Top users reported higher pain scores [median (IQR): 2 (2, 4)] compared to standard users [1 (0, 3), P = 0.01]. However, there was no difference in opioid consumption between unilateral neck exploration, bilateral exploration, or thyroidectomy and parathyroidectomy, P = 0.11. There was no difference in opioid consumption by age, sex, or BMI (all P > 0.05). Of those receiving a prescription, 94.6% had left-over opioids at the time of survey, resulting in 82% of prescribed opioids being unused. Conclusions: Over half of patients undergoing parathyroidectomy did not consume any opioid, and very few needed more than 2 d of opioid. Moreover, most patients did not dispose the unused opioids, which put these pills at risk of diversion and misuse. Surgical approach did not change consumption, illustrating that these guidelines are applicable to thyroidectomy given the similarity between techniques. We recommend prescribing nonopioid analgesics for patients undergoing parathyroidectomy.

Original languageEnglish (US)
Pages (from-to)107-114
Number of pages8
JournalJournal of Surgical Research
Volume245
DOIs
StatePublished - Jan 1 2020

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Parathyroidectomy
Opioid Analgesics
Morphine
Thyroidectomy
Guidelines
Prescriptions
Non-Narcotic Analgesics
Neck

Keywords

  • Opioid
  • Parathyroidectomy
  • Postoperative pain
  • Thyroidectomy

ASJC Scopus subject areas

  • Surgery

Cite this

Optimizing Opioid-Prescribing Practices After Parathyroidectomy. / Sada, Alaa; Ubl, Daniel S.; Thiels, Cornelius A.; Cronin, Patricia A.; Dy, Benzon M.; Lyden, Melanie L.; Thompson, Geoffrey B.; McKenzie, Travis J.; Habermann, Elizabeth B.

In: Journal of Surgical Research, Vol. 245, 01.01.2020, p. 107-114.

Research output: Contribution to journalArticle

Sada, A, Ubl, DS, Thiels, CA, Cronin, PA, Dy, BM, Lyden, ML, Thompson, GB, McKenzie, TJ & Habermann, EB 2020, 'Optimizing Opioid-Prescribing Practices After Parathyroidectomy', Journal of Surgical Research, vol. 245, pp. 107-114. https://doi.org/10.1016/j.jss.2019.07.039
Sada A, Ubl DS, Thiels CA, Cronin PA, Dy BM, Lyden ML et al. Optimizing Opioid-Prescribing Practices After Parathyroidectomy. Journal of Surgical Research. 2020 Jan 1;245:107-114. https://doi.org/10.1016/j.jss.2019.07.039
Sada, Alaa ; Ubl, Daniel S. ; Thiels, Cornelius A. ; Cronin, Patricia A. ; Dy, Benzon M. ; Lyden, Melanie L. ; Thompson, Geoffrey B. ; McKenzie, Travis J. ; Habermann, Elizabeth B. / Optimizing Opioid-Prescribing Practices After Parathyroidectomy. In: Journal of Surgical Research. 2020 ; Vol. 245. pp. 107-114.
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abstract = "Background: To help control opioid overprescription, we conducted a large institutional, 3-site initiative to provide discharge prescribing guidelines for different procedures. Our aim is to refine institutional guidelines for parathyroidectomy. Methods: Patients undergoing parathyroidectomy completed a 28-question survey about opioid consumption. Discharge opioid prescription amounts were converted into morphine milligram equivalents (MMEs) and reported as median and interquartile range (IQR). Consumption was dichotomized into top quartile MME users (Q4) versus standard users (Q1, Q3). Univariate analysis compared opioid consumption. Results: A total of 91 patients were included; 90{\%} were opioid-naive. While the median prescribed was 75 (IQR 75, 150) MME, the median consumed was 0 (IQR 0, 20). Top users reported higher pain scores [median (IQR): 2 (2, 4)] compared to standard users [1 (0, 3), P = 0.01]. However, there was no difference in opioid consumption between unilateral neck exploration, bilateral exploration, or thyroidectomy and parathyroidectomy, P = 0.11. There was no difference in opioid consumption by age, sex, or BMI (all P > 0.05). Of those receiving a prescription, 94.6{\%} had left-over opioids at the time of survey, resulting in 82{\%} of prescribed opioids being unused. Conclusions: Over half of patients undergoing parathyroidectomy did not consume any opioid, and very few needed more than 2 d of opioid. Moreover, most patients did not dispose the unused opioids, which put these pills at risk of diversion and misuse. Surgical approach did not change consumption, illustrating that these guidelines are applicable to thyroidectomy given the similarity between techniques. We recommend prescribing nonopioid analgesics for patients undergoing parathyroidectomy.",
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AU - Dy, Benzon M.

AU - Lyden, Melanie L.

AU - Thompson, Geoffrey B.

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AB - Background: To help control opioid overprescription, we conducted a large institutional, 3-site initiative to provide discharge prescribing guidelines for different procedures. Our aim is to refine institutional guidelines for parathyroidectomy. Methods: Patients undergoing parathyroidectomy completed a 28-question survey about opioid consumption. Discharge opioid prescription amounts were converted into morphine milligram equivalents (MMEs) and reported as median and interquartile range (IQR). Consumption was dichotomized into top quartile MME users (Q4) versus standard users (Q1, Q3). Univariate analysis compared opioid consumption. Results: A total of 91 patients were included; 90% were opioid-naive. While the median prescribed was 75 (IQR 75, 150) MME, the median consumed was 0 (IQR 0, 20). Top users reported higher pain scores [median (IQR): 2 (2, 4)] compared to standard users [1 (0, 3), P = 0.01]. However, there was no difference in opioid consumption between unilateral neck exploration, bilateral exploration, or thyroidectomy and parathyroidectomy, P = 0.11. There was no difference in opioid consumption by age, sex, or BMI (all P > 0.05). Of those receiving a prescription, 94.6% had left-over opioids at the time of survey, resulting in 82% of prescribed opioids being unused. Conclusions: Over half of patients undergoing parathyroidectomy did not consume any opioid, and very few needed more than 2 d of opioid. Moreover, most patients did not dispose the unused opioids, which put these pills at risk of diversion and misuse. Surgical approach did not change consumption, illustrating that these guidelines are applicable to thyroidectomy given the similarity between techniques. We recommend prescribing nonopioid analgesics for patients undergoing parathyroidectomy.

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