Interventions reduce opioid prescribing after neck dissection for thyroid cancer
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DALLAS — Preoperative counseling and perioperative pain management strategies significantly reduced opioid prescriptions at discharge for patients who underwent lateral neck dissection for thyroid cancer, according to study results.
The results — presented at American Head & Neck Society Annual Meeting — showed the range of discharge opioids for patients who undergo neck dissection for thyroid cancer could be 0 to 125 morphine milligram equivalents (MME), equivalent to 15 tablets of 5 mg oxycodone or 25 tablets of 5 mg hydrocodone.
“After routine surgery, we were routinely prescribing opioids. A lot of them go unused, subsequently get diverted and misused, and then contribute to [the opioid epidemic],” researcher Jennifer March, MD, MS, resident at Oregon Health & Science University, told Healio. “If we can manage our prescribing power, maybe we can decrease the number of people who get exposed to opioids outside of our power.”
Background
Prior studies have demonstrated thyroidectomy or parathyroidectomy requires very few opioids postoperatively for opioid-naive patients if they receive appropriate preoperative counseling and multimodal nonopioid pain modalities are implemented, March said.
The need for opioids after lateral neck dissection performed for thyroid cancer had not been established, according to study background.
March and colleagues conducted a retrospective cohort study of 417 patients who underwent lateral neck dissection for thyroid cancer.
Researchers divided the patients into two cohorts. One included 171 treated prior to implementation of programmatic opioid reduction measures implemented at their institution. The other group included 246 patients treated after implementation of these measures.
March and colleagues sought to evaluate the effect of programmatic opioid reduction measures on postoperative prescribing and determine discharge opioid requirements.
Study protocol excluded patients with hospital stays longer than 3 days, as well as those who underwent more extensive surgical procedures.
The pre- and post-intervention groups appeared comparable with regard to average age (47.1 years vs. 46.2 years), sex (female, 61% vs. 60%), race (non-Hispanic white, 84.2% vs. 83.7%), pathology (papillary, 91.8% vs. 83.7%) and extent of surgery (unilateral neck dissection only, 31.6% vs. 30.1%; unilateral neck dissection and central neck dissection, 10.5% vs. 13.4%; unilateral neck dissection plus total or hemithyroidectomy plus central neck dissection, 45.6% vs. 48%).
Results
Extent of surgery did not have a strong effect on postoperative MME required, March said.
The median MME of opioids prescribed declined significantly after implementation of the intervention.
Researchers observed this trend for inpatient administration (22.5 MME vs. 0 MME; 2ES = 0.03; 95% CI, 0.01-0.07) and prescribing at discharge (225 MME vs. 0 MME; 2ES = 0.26; 95% CI, 0.19-0.33).
The percentage of patients who received no opioids during inpatient stays increased from 29% prior to the intervention to 55% after. The percentage of patients discharged with opioids despite receiving none during their inpatient stay declined from 80% prior to the intervention to 18% after.
“There was no difference in the proportion of patients who called in postoperatively requesting refills ... and there was no difference in the quantity of opioids provided to those patients at that time,” March said.
Implications
The results appeared in line with what researchers hypothesized, March said.
“They surprised some of our other practitioners but in a very encouraging way, in that this has really changed the prescribing practices at our institution,” she told Healio. “The key is to assess each patient separately. Not everybody is exactly the same, and decisions should be tailored to each individual patient.”
Collapse
March J, et al. Abstract AHNS053. Presented at: American Head & Neck Society Annual Meeting at COSM 2022; April 27-28, 2022; Dallas.
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