PMID- 35873237
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220726
IS  - 1664-0640 (Print)
IS  - 1664-0640 (Electronic)
IS  - 1664-0640 (Linking)
VI  - 13
DP  - 2022
TI  - Peri-Operative Pain and Opioid Use in Opioid-Naive Patients Following Inpatient 
      Head and Neck Surgery.
PG  - 857083
LID - 10.3389/fpsyt.2022.857083 [doi]
LID - 857083
AB  - Pain management is an important consideration for Head and Neck Cancer (HNC) 
      patients as they are at an increased risk of developing chronic opioid use, which 
      can negatively impact both quality of life and survival outcomes. This 
      retrospective cohort study aimed to evaluate pain, opioid use and opioid 
      prescriptions following HNC surgery. Participants included patients undergoing 
      resection of a head and neck tumor from 2019-2020 at a single academic center 
      with a length of admission (LOA) of at least 24 h. Exclusion criteria were a 
      history of chronic pain, substance-use disorder, inability to tolerate multimodal 
      analgesia or a significant post-operative complication. Subjects were compared by 
      primary surgical site: Neck (neck dissection, thyroidectomy or parotidectomy), 
      Mucosal (resection of tumor of upper aerodigestive tract, excluding oropharynx), 
      Oropharyngeal (OP) and Free flap (FF). Average daily pain and total daily opioid 
      consumption (as morphine milligram equivalents, MME) and quantity of opioids 
      prescribed at discharge were compared. A total of 216 patients met criteria. Pain 
      severity and daily opioid consumption were comparable across groups on 
      post-operative day 1, but both metrics were significantly greater in the OP group 
      on the day prior to discharge (DpDC) (5.6 (1.9-8.6), p < 0.05; 49 +/- 44 MME/day, p 
      < 0.01). The quantity of opioids prescribed at discharge was associated with 
      opioid consumption on the DpDC only in the Mucosal and FF groups, which had 
      longer LOA (6-7 days) than the Neck and OP groups (1 day, p < 0.001). Overall, 
      65% of patients required at least one dose of an opioid on the DpDC, yet 76% of 
      patients received a prescription for an opioid medication at discharge. A longer 
      LOA (aOR = 0.82, 95% CI: 0.63-0.98) and higher Charlson Comorbidity Index (aOR = 
      0.08, 95% CI: 0.01-0.48) were negatively associated with receiving an opioid 
      prescription at the time of discharge despite no opioid use on the DpDC, 
      respectively. HNC patients, particularly those with shorter LOA, may be 
      prescribed opioids in excess of their post-operative needs, highlighting the need 
      the for improved pain management algorithms in this patient population. Future 
      work aims to use prospective surveys to better define post-operative and 
      outpatient pain and opioid requirements following HNC surgery.
CI  - Copyright (c) 2022 Trakimas, Perez-Heydrich, Mandal, Tan, Gourin, Fakhry, Koch, 
      Russell, Tufano, Eisele and Vosler.
FAU - Trakimas, Danielle R
AU  - Trakimas DR
AD  - Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins Hospital, 
      Baltimore, MD, United States.
FAU - Perez-Heydrich, Carlos
AU  - Perez-Heydrich C
AD  - Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins Hospital, 
      Baltimore, MD, United States.
FAU - Mandal, Rajarsi
AU  - Mandal R
AD  - Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins Hospital, 
      Baltimore, MD, United States.
FAU - Tan, Marietta
AU  - Tan M
AD  - Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins Hospital, 
      Baltimore, MD, United States.
FAU - Gourin, Christine G
AU  - Gourin CG
AD  - Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins Hospital, 
      Baltimore, MD, United States.
FAU - Fakhry, Carole
AU  - Fakhry C
AD  - Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins Hospital, 
      Baltimore, MD, United States.
FAU - Koch, Wayne M
AU  - Koch WM
AD  - Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins Hospital, 
      Baltimore, MD, United States.
FAU - Russell, Jonathon O
AU  - Russell JO
AD  - Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins Hospital, 
      Baltimore, MD, United States.
FAU - Tufano, Ralph P
AU  - Tufano RP
AD  - Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins Hospital, 
      Baltimore, MD, United States.
FAU - Eisele, David W
AU  - Eisele DW
AD  - Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins Hospital, 
      Baltimore, MD, United States.
FAU - Vosler, Peter S
AU  - Vosler PS
AD  - Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins Hospital, 
      Baltimore, MD, United States.
LA  - eng
PT  - Journal Article
DEP - 20220708
PL  - Switzerland
TA  - Front Psychiatry
JT  - Frontiers in psychiatry
JID - 101545006
PMC - PMC9305070
OTO - NOTNLM
OT  - head and neck surgery
OT  - opioids
OT  - pain
OT  - post-operative analgesia
OT  - prescriptions
COIS- The authors declare that the research was conducted in the absence of any 
      commercial or financial relationships that could be construed as a potential 
      conflict of interest.
EDAT- 2022/07/26 06:00
MHDA- 2022/07/26 06:01
PMCR- 2022/07/08
CRDT- 2022/07/25 03:32
PHST- 2022/01/18 00:00 [received]
PHST- 2022/06/16 00:00 [accepted]
PHST- 2022/07/25 03:32 [entrez]
PHST- 2022/07/26 06:00 [pubmed]
PHST- 2022/07/26 06:01 [medline]
PHST- 2022/07/08 00:00 [pmc-release]
AID - 10.3389/fpsyt.2022.857083 [doi]
PST - epublish
SO  - Front Psychiatry. 2022 Jul 8;13:857083. doi: 10.3389/fpsyt.2022.857083. 
      eCollection 2022.