Most patients who receive opioids after routine cervical endocrine surgery do not take them: JAMA

Most patients who receive opioids after routine cervical endocrine surgery do not take them revealed a study published in JAMA. The results also reveal a large variation in opioid prescribing patterns among clinicians who care for these patients.

The opioid epidemic has stimulated initiatives to reduce the number of unnecessary narcotic prescriptions. Opioid overprescription is a major factor contributing to the opioid crisis. The authors of this study hypothesized that current prescribing practices at the study institution were variable and poorly reflected actual patient needs. Lancaster and colleagues conducted an observational study to develop patient-centered analgesia-prescribing practices for patients undergoing endocrine surgery.

This is an observational study of patients who underwent endocrine surgery at a single academic medical center from April 2017 through December 2017. Patients undergoing thyroidectomy, parathyroidectomy, and/or neck dissection were called on postoperative day 1 and asked if they were prescribed opioid pain medication and, if so if they had taken any of that medication since discharge. Opioid-prescribing data were collected from the electronic health record system and converted into oral morphine equivalents (OMEs). The authors used χ2 tests with Fisher exact tests and t-tests for analysis with multivariable regression as appropriate. All P values less than .05 were regarded as significant. Data analyses were performed using Stata version 15 (Stata Corporation).

EHR data indicated that 219 (83.6%) had received an opioid prescription. However, 115 patients (52.5%) indicated not using any of the medication. To learn more about postoperative opioid use, the researchers surveyed patients on postoperative day 1, and 222 patients (83.6%) responded. Of those, 194 patients had received an opioid prescription and were included in the analysis.

Researchers found opioid use post-surgery was associated with younger mean age and longer mean surgical time compared with those who did not take opioids post-surgery, as well as undergoing neck dissection. However, there was wide variation in the number of opioids prescribed, with a median range of 75 to 200 oral morphine equivalents (OMEs) between individual physicians.

Although there will be a subset of patients for whom opioids are appropriate, these medications should be judiciously used, concluded the authors.

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doi:10.1001/jamasurg.2019.2518