Skip to main content
AAO-HNSF 2024 Annual Meeting & OTO EXPO Main banner
Icon Legend
This session is not in your schedule.
This session is in your schedule. Click again to remove it.
Back

Scientific Oral Presentations

Care Equity, Quality, and Safety

Session: Scientific Oral Presentations 2 - Care Equity, Quality, and Safety

Improving Multimodal Analgesic Use at Discharge After Inpatient and Outpatient Otolaryngologic Surgery

Monday, September 30, 2024
8:30 AM – 8:36 AM EDT
Location: MBCC, 235-237
Disclosure(s):
Karolina A. Plonowska-Hirschfeld, MD:

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

Jose S. Herrera, RN, MSN, CNL:

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

Jolie L. Chang, MD:

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

Andrew N. Goldberg, MD, MSCE:

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

Megan L. Durr, MD:

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

Introduction: In recent studies, nearly 75% of the prescribed opiates were unused postoperatively after otolaryngologic procedures. As a result, our department implemented measures to decrease opiate prescriptions at discharge and improve patient education on multi-modal analgesic use in the perioperative setting.

Methods: We performed a retrospective review of opioid, acetaminophen, and non-steroidal anti-inflammatory drugs (NSAIDs) prescribed at discharge after otolaryngologic procedures at a single academic medical center. Two annual department-wide workshops were hosted in February 2022 and 2023, where each subspecialty working group reviewed literature on multi-modal analgesic protocols. Concurrently, a patient survey was distributed to evaluate discharge pain medication use. Recommendations from each working group and survey results were compiled to develop standardized discharge instructions to optimize non-opiate pain medication use. Subsequent trends in opioid, acetaminophen, and NSAIDs prescribed at discharged were analyzed.

Results: For 2,469 discharges in 2019, 65% of patients were discharged with an opioid prescription (median 20 tabs of 5 mg oxycodone equivalent), whereas 24% received Tylenol and 9% were prescribed an NSAID. For 35 patients surveyed after sinus and otologic surgery, 9 (26%) reported using none of the opioids prescribed. Following department workshops, among 2,297 patients discharged between January and October of 2023, 47% were prescribed opioids at discharge (38% fewer patients, p = 0.0002) with median 10 tabs of opiates (50% reduction). Additionally, discharge Tylenol and NSAID prescriptions more than doubled to 57% and 39%, respectively (both p < 0.0001).

Conclusions: Institutional review of discharge pain medication prescriptions and departmental workshops can lead to substantial decrease in opioids prescribed. Ongoing efforts by our department will evaluate how these prescription analgesic trends and standardized pain medication instructions affect patient satisfaction with perioperative pain control.

    Presenting Author(s)

  • Karolina A. Plonowska-Hirschfeld, MD

    Fellow
    Washington University in St. Louis
    Saint Louis, MO, United States

    Disclosure(s):

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

    • Co-Author(s)

  • Jose S. Herrera, RN, MSN, CNL

    Clinical Nurse II
    Department of Otolaryngology-Head and Neck Surgery, University of California - San Francisco
    San Francisco, CA, United States

    Disclosure(s):

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

  • JC

    Jolie L. Chang, MD

    Associate Professor, Otolaryngology HNS
    University of California San Francisco
    San Francisco, CA, United States

    Disclosure(s):

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

  • Andrew N. Goldberg, MD, MSCE

    Professor
    University of California San Francisco
    San Francisco, CA, United States

    Disclosure(s):

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

  • Rahul Seth, MD

    Facial Plastic Surgery
    Golden State Plastic Surgery / UCSF
    Walnut Creek, CA, United States

    Disclosure information not submitted.

    • Senior Author(s)

  • Megan L. Durr, MD

    Associate Professor
    University of California, San Francisco
    San Francisco, California, United States

    Disclosure(s):

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