Hospital Fray Bernardino Alvarez, Ciudad de México, México

Background We carried out a significant institutional, three-site initiative to provide discharge prescribing guidelines for various procedures in an effort to reduce the overprescription of opioids. Our goal is to improve institutional recommendations for parathyroid surgery. Methods A 28-question survey about opioid use was completed by patients having parathyroidectomies. The morphine milligramme equivalents (MMEs) of the discharge opioid prescription quantities were given as the median and interquartile range (IQR). It was decided to divide consumption between top quartile MME users (Q4) and standard users (Q1, Q3). Analyses with only one variable compared opioid usage. Results There were 91 patients altogether, 90% of whom had never used opioids. The median consumed was 0, but the median amount prescribed was 75 (IQR 75, 150) MME (IQR 0, 20). Top users reported more discomfort than normal users [1 (0, 3), P = 0.01; median (IQR): 2 (2, 4). Opioid consumption did not differ between unilateral neck exploration, bilateral neck exploration, thyroid surgery, or parathyroid surgery (P = 0.11). By age, sex, or BMI, there were no differences in opioid intake (all P > 0.05). At the time of the survey, 94.6% of people who had received a prescription had leftover opioids, leaving 82% of the drugs unutilized. Conclusions Few patients who underwent parathyroidectomy required more than two days of opioid, and more than half of patients did not take any at all. Additionally, the majority of patients did not discard their leftover opioids, which made them vulnerable to theft and abuse. Consumption was unaffected by the surgical strategy, demonstrating that same recommendations apply to thyroidectomy given the comparability of the two treatments. We advise doctors to give nonopioid analgesics to patients having parathyroidectomies.

Opioid, Parathyroidectomy, Postoperative pain, Thyroidectomy

Pellon G. Improving Opioid Prescription Techniques Following Parathyroidectomy. Insights Journal of Surgery and Clinical Case Reports 2019.