Patients Undergoing Thyroid Surgery May Require Few Opioids

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Investigators sought to identify  opioid prescribing practice patterns and postoperative opioid requirements.
Investigators sought to identify opioid prescribing practice patterns and postoperative opioid requirements.

Patients undergoing thyroid and parathyroid surgery may require few to no opioid medications postoperatively, according to a study published in JAMA Otolaryngology-Head & Neck Surgery.

A total of 1788 opioid-naive patients (mean age, 51.2 years) who underwent parathyroidectomy (n=723), hemithyroidectomy (n=400), or total thyroidectomy (n=642) at a high-volume academic endocrine surgery center in Oregon were enrolled. Investigators sought to identify opioid prescribing practice patterns and postoperative opioid requirements. 

Morphine milligram equivalents (MMEs) were used to determine the quantity of opioids prescribed. In addition, the investigators analyzed postdischarge opioid refill data. Patients were divided into 2 groups: patients in group 1 (past prescribing practices) had surgery between January 2012 and September 2016 (n=1336) and those in group 2 (current prescribing practices) had surgery between October 2016 and December 2017 (n=429). In patients undergoing parathyroidectomy, the mean prescribed opioid quantity was 176.20±86.60 MME in group 1 and 80.08±74.43 MME in group 2 (effect size, 1.139). 

For hemithyroidectomy, patients in group 1 were prescribed a mean of 204.65±112.24 MME and those in group 2 received a mean of 112.24±102.31 MME (effect size, 0.842). In patients who underwent total thyroidectomy, those in group 1 were prescribed a mean of 214.87±161.09 MME and those in group 2 were given a mean of 102.29±87.72 MME (effect size, 0.754).

The percentage of patients discharged without a prescription for any opioid analgesic were 57.5%, 37.5%, and 33.3% for patients undergoing parathyroidectomy, hemithyroidectomy, and total thyroidectomy, respectively, in the last quarter of 2017. There was no increase in the number of calls by patients requesting opioid medications or refills, particularly in patients who were prescribed <75.0 MME postoperatively.

A limitation of the analysis was the lack of data on the quantity of postoperative opioid medication consumed by patients.

“Preoperative counselling of patients regarding pain and adding nonopioid adjuncts can help to minimize the quantity of opioids that are used,” noted the study authors. “These patients have relatively little postoperative pain that can be potentially controlled entirely with nonopioid medications. Decreasing the volume of opioid medication prescribed at discharge will decrease waste and reduce potential for addiction.”

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Reference

Shindo M, Lim J, Leon E, Moneta L, Li R, Quintinalla-Diek L. Opioid prescribing practice and needs in thyroid and parathyroid surgery [published online October 25, 2018]. JAMA Otolaryngol Head Neck Surg. doi: 10.1001/jamaoto.2018.2427

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