[Skip to Navigation]
Views 267
Citations 0
Comment & Response
November 14, 2019

Opioid Prescriptions and Risk of Complications After Tonsillectomy in Children—Reply

Author Affiliations
  • 1Department of Pediatrics, University of Michigan Medical School, Ann Arbor
  • 2Department of Surgery, University of Michigan Medical School, Ann Arbor
  • 3Department of Otolaryngology–Head and Neck Surgery, University of Michigan Medical School, Ann Arbor
JAMA Otolaryngol Head Neck Surg. 2020;146(2):209. doi:10.1001/jamaoto.2019.3432

In Reply Sun and colleagues raise important points regarding primary hemorrhage, surgical technique, and nonopioid analgesics. Our decision to not examine primary hemorrhage in our study1 was driven by 2 considerations. First, primary hemorrhage occurs within 24 hours of surgery (eg, on the day of surgery or the day after). Therefore, any putative effect of perioperative opioid prescribing on the risk of primary hemorrhage (eg, by reducing the use of nonsteroidal anti-inflammatory drugs [NSAIDs]) would have to be strong and immediate. However, prior studies do not suggest that the association between NSAID use and hemorrhage is large, if it exists at all.2-5 Given the lack of a reasonable a priori mechanism between perioperative opioid prescribing and primary hemorrhage, any detected association would most likely be incidental or due to confounding. Second, our definition of perioperative opioid prescription included opioid prescriptions filled from a week before surgery to 1 day after surgery. To establish a clear temporal relationship between perioperative opioid prescriptions and primary hemorrhage, we would have needed to exclude prescriptions filled the day after surgery while only analyzing primary hemorrhages that occurred on the day after surgery.

Limit 200 characters
Limit 25 characters
Conflicts of Interest Disclosure

Identify all potential conflicts of interest that might be relevant to your comment.

Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.

Err on the side of full disclosure.

If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.

Not all submitted comments are published. Please see our commenting policy for details.

Limit 140 characters
Limit 3600 characters or approximately 600 words