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Original Investigation
December 2018

Opioid Prescribing Practice and Needs in Thyroid and Parathyroid Surgery

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, Oregon Health and Science University, Portland
  • 2Department of Surgery, Oregon Health and Science University, Portland
JAMA Otolaryngol Head Neck Surg. 2018;144(12):1098-1103. doi:10.1001/jamaoto.2018.2427
Key Points

Question  What is the postoperative opioid prescribing practice and true need for opioids after thyroidectomy and parathyroidectomy?

Findings  In a cohort study of 1702 patients undergoing 1765 thyroidectomy and parathyroidectomy procedures, the mean postoperative prescribed dose of opioids was shown to be significantly reduced after initiation of preoperative patient education and use of nonopioid medications. In the last quarter of 2017, the mean (SD) dose prescribed was 19.90 (26.60) morphine milligram equivalents for parathyroidectomy, 56.72 (61.65) morphine milligram equivalents for hemithyroidectomy, and 68.15 (68.47) morphine milligram equivalents for total thyroidectomy.

Meaning  Results of the study suggest that patients undergoing thyroid and parathyroid surgery need little opioid treatment postoperatively.

Abstract

Importance  In recent years, the medical community’s inadvertent contribution to opioid addiction has been recognized.

Objective  To determine the opioid prescribing practices and opioid needs for patients undergoing thyroid and parathyroid surgery to help reduce postoperative opioid administration.

Design, Setting, and Participants  This retrospective cohort study included 1788 opioid-naive patients who underwent thyroid and parathyroid surgery from January 1, 2012, through December 31, 2017, at the high-volume academic endocrine surgery center at Oregon Health and Sciences University. Patients with long-term opioid treatment and those who underwent other head and neck procedures or robotic thyroidectomy were excluded. For analysis, 1765 procedures were available (723 parathyroidectomy, 400 hemithyroidectomy, and 642 total thyroidectomy).

Main Outcomes and Measures  The quantity of prescribed opioids was determined in morphine milligram equivalents (MME). Opioid refill data after discharge were also analyzed. Patients were then divided into past (1336 in group 1 [January 1, 2012, to September 30, 2016]) and current (429 in group 2 [October 31, 2016, to December 31, 2017]) prescribing practices. For each procedure, the mean quantity prescribed for each group, difference between the means, 95% CI for the difference, and effect size were calculated.

Results  A total of 1702 patients (80.0% female [n = 1361]; mean age, 51.2 years [range, 7-97 years]) undergoing 1765 procedures were included in the analysis. For parathyroidectomy, the mean (SD) opioid quantity prescribed was 176.20 (86.66) MME in group 1 vs 80.08 (74.43) MME in group 2 (effect size, 1.139); for hemithyroidectomy, 204.65 (112.24) MME in group 1 vs 112.24 (102.31) MME in group 2 (effect size, 0.842); and for total thyroidectomy, 214.87 (161.09) MME for group 1 vs 102.29 (87.72) MME for group 2 (effect size, 0.754). In the last quarter of 2017, the numbers of patients discharged without any opioid prescription were 15 of 26 (57.5%) for parathyroidectomy, 12 of 32 (37.5%) for hemithyroidectomy, and 9 of 27 (33.3%) for total thyroidectomy. Patient calls requesting pain medications for group 2 were similar or fewer, depending on the procedure. Those who were prescribed less than 75.0 MME postoperatively did not call for additional opioid prescriptions.

Conclusions and Relevance  Our study suggests that patients undergoing thyroid and parathyroid surgery need little, if any, postoperative opioids.

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