L. I. Ruffolo1, K. M. Jackson1, T. Chennell1, D. M. Glover1, J. Moalem1 1University Of Rochester,Department Of Surgery,Rochester, NY, USA
Introduction:
We adopted an opt-in narcotic prescription program for patients undergoing outpatient thyroid and parathyroid surgery. All patients received preoperative bilateral cervical blocks, and perioperative pain management was at the discretion of the anesthesia and perioperative staff. Patients were discharged with acetaminophen, unless they requested narcotic medications. Here we report our experience with this program, as well as the factors which correlated with patients requesting narcotic prescription for discharge.
Methods:
We prospectively collected data on patient demographics, their medical/social history, operative details, and postoperative pain medication use and prescription. Univariate and multivariate analyses were performed using Student’s T test for continuous variables, Chi square analysis for categorical variables, and nominal logistic regression. Patients who requested narcotics at discharge were contacted at least 1 month following surgery to determine the number and disposal status of any unused narcotic tablets. This study was approved by the university’s institutional review board.
Results:
Of 219 patients who had outpatient surgery during our study, only nine (4%) requested narcotic prescription at discharge, and none called after discharge to request analgesic prescription. Univariate analysis demonstrated that patients with longer incisions (p=0.007) or with a history of substance abuse (p<0.001), anxiety (p=0.012), depression (p<0.001), baseline narcotic use (p=0.002), or elevated higher pain scores post anesthesia (p=0.003) were more likely to request narcotic medications at discharge. Multivariate logistic regression again demonstrated larger incision length (OR 42.6, CI 1.12-1612, p=0.04) and history of substance abuse (OR 52.3, CI 1.6-1713, p=0.01) as predictive of requesting narcotic prescriptions.
Patients who opted to receive a narcotic prescription received 10-20 tablets of hydrocodone-acetaminophen (mean=16.1). All of the patients used at least one of the prescribed pills, and 2 used all of their prescribed pills. In total, 74 (51%) of the 145 tablets prescribed were consumed. On follow up call 1 month after surgery, none of the unused tablets were disposed of and all remained in the patients’ medicine cabinets.
Conclusion:
The vast majority of patients can be comfortably managed without narcotic medications after thyroid and parathyroid surgery. No patient who was discharged without narcotics called to request a prescription. Both patient and procedural factors contribute to narcotic requirement at discharge.
Even under this paradigm, approximately half of the prescribed pain tablets were unused, and were retained in patients’ homes. Ongoing efforts to reduce unnecessary narcotic prescriptions, as well as community educational programs and mechanisms for narcotic disposal remain paramount for reducing narcotics tablets at risk for diversion.