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Scientific Oral Presentations

Head and Neck Surgery

Session: Scientific Oral Presentations 9 - Head and Neck Surgery

Unveiling Prescribing Patterns: Systematic Review of Chronic Opioid Prescriptions After Head and Neck Cancer Surgeries

Tuesday, October 1, 2024
10:00 AM – 10:06 AM EDT
Location: MBCC, 208
Disclosure(s):
Sabin Karki, MS:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Brooke Stephanian, BS:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Mirian Ramirez, MLIS:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Michael W. Sim, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Jessica A. Yesensky, MD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Janice L. Farlow, MD, PhD:

faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

Introduction: Despite recent interest in opioid-sparing multimodal analgesia for pain management in head and neck cancer (HNC) patients undergoing surgery, it is unclear whether there have been widespread changes in opioid prescribing. We thus aimed to systematically review postoperative chronic opioid use.

Methods: This study followed PRISMA guidelines and was registered with PROSPERO. MEDLINE, Embase, and CENTRAL were queried for studies evaluating opioid prescriptions after major HNC from 1998-2021, excluding case reports. Primary outcomes included prevalence and patterns of opioid use post-surgery, and related outcomes like chronic use and side effects.

Results: Out of 1,278 abstracts, 31 studies (17,370 patients) from the US, China, and Canada met inclusion criteria. Study quality was moderate (MINORS average score = 11/16). Persistent postoperative opioid use, defined as prescriptions 90 days after treatment, was noted in 13%-21.8% of opioid-naive patients. Two studies reported adverse events, with up to 40% of patients experiencing side effects. Risk factors for chronic use included preoperative opioid use, tobacco use, higher cancer stage, adjuvant treatment, and demographic factors. Larger opioid prescriptions were correlated with shorter survival in advanced cancers. There was notable variability in patient-reported pain control.

Conclusions: Persistent opioid use post-HNC surgery is common, with variable efficacy and risk of adverse effects. Tailoring pain management to individual risk factors and focusing on multimodal analgesia could reduce the risks of persistent opioid use. Future prospective studies are required to identify optimal pain management strategies.

    Presenting Author(s)

  • Sabin Karki, MS

    Medical Student
    Indiana University School of Medicine
    Indianapolis, IN, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

    • Co-Author(s)

  • Sabin Karki, MS

    Medical Student
    Indiana University School of Medicine
    Indianapolis, IN, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

    • Presenting Author(s)

  • BS

    Brooke Stephanian, BS

    medical student
    Indiana University School of Medicine
    Indianapolis, IN, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

    • Co-Author(s)

  • BS

    Brooke Stephanian, BS

    medical student
    Indiana University School of Medicine
    Indianapolis, IN, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

  • MR

    Mirian Ramirez, MLIS

    Assistant Librarian, Ruth Lilly Medical Library
    Indiana University School of Medicine
    Indianapolis, IN, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

  • Michael W. Sim, MD

    Associate Professor
    Indiana University
    Zionsville, IN, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

  • JY

    Jessica A. Yesensky, MD

    Assistant Professor of Otolaryngology - Head and Neck Surgery
    Indiana University School of Medicine
    Indianapolis, Indiana, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.

  • AM

    Avinash Mantravadi, MD

    Associate Professor of Clinical Otolaryngology - Head and Neck Surgery
    Indiana University School of Medicine, United States

    Disclosure information not submitted.

    • Senior Author(s)

  • Janice L. Farlow, MD, PhD

    Assistant Professor
    Indiana University Department of Otolaryngology - Head and Neck Surgery
    Indianapolis, IN, United States

    Disclosure(s):

    faculty for this accredited education activity has no relationship(s) with ineligible companies to disclose.