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A Prospective Evaluation of Postoperative Opioid Use in Otologic Surgery

Qian, Z. Jason*; Alyono, Jennifer C.*,†; Woods, Ong-Dee; Ali, Noor*; Blevins, Nikolas H.*,†

doi: 10.1097/MAO.0000000000002364
MIDDLE EAR AND MASTOID DISEASE
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Objective: To prospectively evaluate opioid consumption following adult outpatient otologic surgery.

Study Design: Prospective observational.

Setting: Single-tertiary referral center.

Patients: Patients scheduled for otologic surgery who did not have a history of chronic opioid use were recruited between February 2018 and February 2019.

Interventions and Main Outcome Measures: Opioid consumption was queried using telephone or in-person surveys administered between postoperative days 5 and 15. Patient demographics, surgical details, and opioid prescription patterns were abstracted from medical records. Opioid distribution was determined by querying records maintained by the California Department of Justice through a state-wide prescription drug monitoring program mandated since 2016.

Results: Seventy patients were prescribed an average of 68.9 ± 31.8 mg of morphine equivalents (MME) and consumed 47.3 ± 42.9 MME over 2.4 ± 2.3 days postoperatively. Patients who received a postauricular incision were prescribed significantly more than those who underwent transcanal procedures (86.2 vs 55.9 MME; t test, p < 0.001), consumed significantly more (72.2 vs 28.6 MME; t test, p < 0.001), and for a significantly longer duration (3.4 vs 1.6 days; t test, p = 0.001). In the postauricular group, there was no significant difference in consumption between mastoidectomy and nonmastoidectomy subgroups (64.9 vs 89.2 MME; t test, p = 0.151). Eighty percent of transcanal patients consumed 50 MME (10 pills) or less, while 80% of postauricular patients consumed 80 MME (16 pills) or less.

Conclusions: Patients in our cohort consumed approximately 3/4 of the prescribed opioids. Those with postauricular incisions used significantly more than those with transcanal incisions. Postoperative opioid prescription recommendations should be tailored according to the extent of surgery.

*Department of Otolaryngology—Head and Neck Surgery, Stanford University School of Medicine

Stanford Ear Institute, Stanford, California

Address correspondence and reprint requests to Nikolas H. Blevins, M.D., Department of Otolaryngology—Head and Neck Surgery, Stanford University School of Medicine, 801 Welch Road, 2nd Floor, Stanford, CA 94305; E-mail: nblevins@stanford.edu

Abstract presented as a poster at the American Otological Society Spring Meeting 2019.

The authors disclose no conflicts of interest.

Copyright © 2019 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company