番茄社区

DALLAS -- A hospital intervention program dramatically reduced the number of thyroid cancer patients discharged with opioid prescriptions after lateral neck dissection, a retrospective cohort study found.

For patients who underwent surgery prior to the intervention program, the median morphine milliequivalents (MME) prescribed at discharge per patient was 225 MME compared with 0 MME for patients who underwent surgery after program implementation, which included patient and provider counseling and education, reported Jennifer March, MD, of Oregon Health & Science University in Portland, and colleagues.

A multiple linear regression analysis of sex, age, race/ethnicity, extent of surgery, and opioid reduction intervention showed that the intervention program had a large clinically meaningful association with reducing opioid prescriptions and dosage amounts at discharge (η²ES 0.26, 95% CI 0.19-0.33), they wrote in .

"Preoperative counseling and multimodal pain control resulted in a significantly reduced amount of opioids needed postoperatively," March said during the annual meeting of the American Head and Neck Society, where the study results were presented. "Assessing if the patient truly needed opioids at discharge, based on their needs while in the hospital, led to a decrease in the amount of opioids prescribed at discharge."

If this caused late pain in the patients, it wasn't obvious. "The decreased opioid prescribing practices did not result in an increase in request for opioids postoperatively," March noted.

Commenting on the study, Sarah Rohde, MD, of Vanderbilt University Medical Center in Nashville, told 番茄社区 that "since patients were able to request opioids if needed, this shows that in this intervention opioids were not being withheld from patients. The doctors were trying to be more judicious in prescribing these drugs for procedures that are not generally painful."

"While we should be striving to reduce the prescription of the drugs, we have to realize that every patient case is unique and we have to consider the patient at the heart of the matter. Overall, we should be paying more attention to the amount of opioids being prescribed," she added.

March suggested that, based on the study results, the dosing range needed at discharge is 0 to 125 MME, which translates to 15 tablets of 5-mg oxycodone or 25 tablets of 5-mg hydrocodone.

"The findings of this retrospective cohort study suggest that patients undergoing lateral neck dissections for thyroid cancer with short hospitalization needed very small amounts, if any, postoperative opioid medication for pain management," the authors wrote. "Adequate postoperative pain control was achieved using non-opioid interventions. Implementing an intervention to decrease the quantity of unnecessarily prescribed opioid medications during hospital discharge may help to reduce the risk of opioid addiction and overdose in patients after surgery."

For this study, March and team analyzed data from the electronic health records of 417 patients who underwent lateral neck dissection for thyroid cancer from June 2011 to June 2021. Patients who required extensive treatment such as tracheal resection were excluded, as were those who required a hospital stay longer than 3 days. The included patients were divided into two groups: 171 patients (mean age 47, 61% women, 84% white) treated prior to the intervention (June 2011 to January 2017), and 246 patients (mean age 46, 60% women, 83.7% white) treated following program implementation (February 2017 to June 2021).

Even in situations where patients required no in-hospital pain medication, as many as 80% were sent home with opioid prescriptions before the start of the program. This dropped to 18% after its implementation, the authors noted, adding that prescriptions were reduced across the different surgery departments (endocrine, head and neck, and oncology).

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