Postoperative Pain Control and Opioid Usage Patterns Among Patients Undergoing Thyroidectomy and Parathyroidectomy

Otolaryngol Head Neck Surg. 2019 Mar;160(3):394-401. doi: 10.1177/0194599818797574. Epub 2018 Oct 16.

Abstract

Objectives: To examine opioid-prescribing patterns after endocrine surgery. To evaluate factors associated with postoperative pain and opioid use.

Study design: Cross-sectional.

Setting: Academic university health system.

Subjects and methods: The study sample included 209 patients who underwent total thyroidectomy, hemithyroidectomy, or parathyroidectomy by 4 surgeons between August 2015 and November 2017. Eighty-nine patients completed a phone survey about postoperative pain and opioid use. Prescription, demographic, and comorbidity data were collected retrospectively. Patient characteristics associated with opioid use, use of ≥10 opioid pills, and pain score were identified via chi-square, t test, analysis of variance, or Pearson correlation. Identified factors were further assessed with multivariable logistic and linear regression modeling.

Results: The median numbers of opioid pills prescribed were 20 for total thyroidectomy, 25 for hemithyroidectomy, and 20 for parathyroidectomy, and the median numbers of pills used were 1.5, 2, and 0, respectively. Of 1947 total prescribed pills, 19.7% were reported to be taken. The number of pills meeting the opioid needs of 80% of these patients was 10. In multivariable analyses, older age was associated with lower odds of opioid use (odds ratio, 0.97; 95% CI, 0.94-0.999; P = .04) and lower pain scores (Pearson correlation coefficient, -0.05; 95% CI, -0.10 to 0.001, P = .04). Charlson Comorbidity Index score >5 was associated with use of ≥10 pills (odds ratio, 6.62; 95% CI, 1.60-27.50; P = .01).

Conclusion: Excess opioids are often prescribed for endocrine surgery. By using an ideal pill number and understanding predictors of postoperative pain, surgeons can more adequately treat pain and limit excess opioid prescriptions.

Keywords: endocrine surgery; opioid; parathyroidectomy; postoperative pain; thyroidectomy.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Analgesics, Opioid / therapeutic use*
  • Cross-Sectional Studies
  • Female
  • Humans
  • Length of Stay
  • Male
  • Middle Aged
  • Pain, Postoperative / diagnosis
  • Pain, Postoperative / drug therapy*
  • Pain, Postoperative / etiology*
  • Parathyroid Diseases / pathology
  • Parathyroid Diseases / surgery
  • Parathyroidectomy / adverse effects*
  • Practice Patterns, Physicians'*
  • Thyroid Diseases / pathology
  • Thyroid Diseases / surgery
  • Thyroidectomy / adverse effects*

Substances

  • Analgesics, Opioid