A. Sada1, D. S. Ubl2, C. A. Thiels1, B. M. Dy1, M. L. Lyden1, G. B. Thompson1, T. J. McKenzie1, E. B. Habermann2 1Mayo Clinic,Department Of Surgery,Rochester, MN, USA 2Mayo Clinic,Surgical Outcomes Program, Robert D And Patricia E Kern Center For The Science Of Health Care Delivery,Rochester, MN, USA
Introduction:
With the increased awareness of the U.S. opioid epidemic, several initiatives have attempted to limit overprescribing of opioids. As the opioids requirements differ based on the procedure and patient specific factors, we conducted a large initiative that resulted in prescribing guidelines for different procedures. The aim of this study is to refine our guidelines for parathyroidectomy.
Methods:
Patients undergoing parathyroidectomy at three academic centers were asked to complete a 28-question telephone survey at 21-35 days post-discharge as part of a larger initiative. Surveys captured opioid consumption and patient experience while patient characteristics were abstracted. Discharge opioids were converted into Morphine Milligram Equivalents (MME) and reported as median and interquartile range (IQR). Univariate comparisons were used. Consumption was dichotomized into top quartile users (Q4), who consumed between 20-217 MME vs standard users (Q1-Q3), who consumed between 0-15 MME.
Results:
A total of 103 patients completed the survey; mean age was 65±12 years, 83% were female and 89% were opioid-naive. At discharge, opioid prescriptions were provided to 86% of patients. While the median prescribed was 75 (IQR 75-125, range 0-375) MME, the median consumed was 0 (IQR 0-20). Half (51%) of patients did not consume any, while only 11% consumed >50 MME. Patients who did not consume opioids reported a median last pain score before discharge of 1 (IQR 0, 2) while patients who did consume opioids reported a median score of 2 (IQR 2, 3), p<0.001.
There was no difference in opioids consumption between unilateral neck exploration (n=71), bilateral exploration (n=26) or thyroidectomy and parathyroidectomy (n=6) (p=0.10).
Overall, 98% of patients were satisfied with their pain control. While 31% reported being prescribed too much opioid, no patients reported they were not prescribed enough. All 4 patients requiring an opioid refill reported it was very easy to get a refill. Of those receiving a prescription, 95% had left-over opioids at the time of survey, resulting in 81% of prescribed opioids being unused. Only 6% of patients disposed of left-over opioids.
Conclusion:
While the majority of patients undergoing parathyroidectomy received opioids after discharge, over half of them did not consume any, and very few consumed more than a day or two of opioid medication. Moreover, surgical approach did not change consumption, illustrating that these guidelines are applicable to thyroidectomy given similarity between incisions and techniques. We recommend prescribing non-opioid analgesics for patients undergoing parathyroidectomy and thyroidectomy and considering less than 40 MME for patients with high pain scores.
