Pain
Medical cannabis or cannabinoids for chronic non-cancer and cancer related pain: a systematic review and meta-analysis of randomised clinical trials.
BMJ (Clinical research ed.) · 2021
Abstract
IMPORTANCE: Persistent opioid use after otolaryngology-head and neck surgery (OHNS) is concerning. However, evidence-based guidelines for managing opioid refill prescriptions within 90 days after discharge, a critical period for the transition from acute to persistent opioid use, are lacking.
OBJECTIVE: To identify perioperative risk factors associated with opioid refills at 1 to 30, 31 to 60, and 61 to 90 days after OHNS procedures.
DESIGN, SETTING, PARTICIPANTS: This cohort study used opioid prescription data from a large academic medical center. The study included adult patients, regardless of opioid-naive status, who underwent inpatient OHNS procedures and were discharged between January 2017 and December 2023.
EXPOSURE: OHNS with a postoperative hospital stay of at least 1 day.
MAIN OUTCOMES AND MEASURES: The primary outcomes were opioid refills at 1 to 30, 31 to 60, and 61 to 90 days after discharge.
RESULTS: Among 4132 adult patients, the median (IQR) age was 62 (49-72) years, and 1870 (45.3%) were female. From 2017 to 2023, despite a substantial reduction in the total oral morphine equivalents (OME) of discharge opioid prescriptions after OHNS procedures, opioid refill rates remained unchanged. In multiple logistic regression analysis, underprescription (adjusted odds ratio [AOR], 1.60 [95% CI, 1.24-2.06]) and overprescription (AOR, 1.58 [95% CI, 1.29-1.95]) of discharge opioid daily doses (defined as ≥7.5 OME lower or higher than the patient's inpatient opioid consumption during the last 24 hours before discharge), compared with a matched prescription, were associated with increased odds of refills within 30 days of discharge. Overprescription was also associated with increased odds of refills at 31 to 60 days (AOR, 1.34 [95% CI, 1.03-1.75]). Other factors associated with increased odds of refills at various time points included preoperative use of opioids, benzodiazepines, and cannabis; higher postsurgical pain levels; receiving a prior refill; and receiving an opioid prescription despite not using any inpatient opioids during the last 24 hours of hospitalization.
CONCLUSION AND RELEVANCE: This cohort study identified independent perioperative risk factors for opioid refills after inpatient OHNS procedures and proposes an evidence-based strategy to reduce refill risk.