J Neurol Surg B Skull Base 2020; 81(03): 301-307
DOI: 10.1055/s-0039-1692473
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Incidence and Predictive Factors for Additional Opioid Prescription after Endoscopic Skull Base Surgery

1   School of Medicine, University of California San Diego, La Jolla, California, United States
,
Aria Jafari
2   Department of Surgery, Division of Otolaryngology—Head and Neck Surgery, University of California San Diego, San Diego, California, United States
,
Jesse R. Qualliotine
2   Department of Surgery, Division of Otolaryngology—Head and Neck Surgery, University of California San Diego, San Diego, California, United States
,
Adam S. DeConde
2   Department of Surgery, Division of Otolaryngology—Head and Neck Surgery, University of California San Diego, San Diego, California, United States
› Author Affiliations
Further Information

Publication History

28 February 2019

11 May 2019

Publication Date:
12 June 2019 (online)

Abstract

Introduction Postoperative pain management and opioid use following endoscopic skull base surgery (ESBS) is not well understood. A subset of patients requires additional opioid prescription (AOP) in the postoperative period. The objective of this study is to describe the incidence of AOP, as well as evaluate patient and surgical characteristics that may predict additional pain management requirements following ESBS.

Methods A retrospective review of cases undergoing ESBS between November 2016 and August 2018 was performed. We reviewed patients' sociodemographic and clinical data, and Controlled Substance Utilization Review and Evaluation System (CURES) records. Stepwise multivariable logistic regressions were performed to evaluate the factors associated with AOP within 60 days following surgery.

Results A total of 42 patients were identified. Indications for ESBS included intracranial mass (64.2%), sinonasal malignancy (23.8%), and skull base reconstruction (9.5%). AOP were recorded in nine patients (21.4%). There were no significant differences in operative factors, including approach, lesion location, or perioperative analgesia between the two cohorts. On multivariable logistic regression, we found that younger age (odds ratio [OR]: 0.891, 95% confidence interval [CI]: 0.79–1.00, p = 0.050), comorbid depression (OR: 86.48, 95% CI: 1.40–5,379.07, p = 0.034), and preoperative opioid use (OR: 104.45, 95% CI: 1.41–7,751.10, p = 0.034) were associated with additional prescriptions postoperatively.

Conclusion The requirement for extended postoperative opioid pain control is common after ESBS. Patient demographics including age and psychosocial factors, such as depression may predict the need for AOP after ESBS. These results suggest that patient-driven factors, rather than surgical characteristics, may determine the need for prolonged pain control requirements after ESBS.

Financial Support

None.


Institutional Review Board

The study was approved by the University of California, San Diego Institutional Review Board (IRB; 161005X).


Presentation at Scientific Conference

The study was accepted for oral presentation at the North American Skull Base Society 29th Annual Meeting on Feb 17, 2019.


 
  • References

  • 1 CDC. 2018 Annual Surveillance Report of Drug-Related Risks and Outcomes—United States. Available at: https://www.cdc.gov/drugoverdose/pdf/pubs/2018-cdc-drug-surveillance-report.pdf . Accessed May 30, 2019
  • 2 Levy B, Paulozzi L, Mack KA, Jones CM. Trends in opioid analgesic-prescribing rates by specialty, U.S., 2007-2012. Am J Prev Med 2015; 49 (03) 409-413
  • 3 Volkow ND, McLellan AT. Opioid abuse in chronic pain--misconceptions and mitigation strategies. N Engl J Med 2016; 374 (13) 1253-1263
  • 4 Hooten WM, Brummett CM, Sullivan MD. , et al. A conceptual framework for understanding unintended prolonged opioid use. Mayo Clin Proc 2017; 92 (12) 1822-1830
  • 5 Brummett CM, Waljee JF, Goesling J. , et al. New persistent opioid use after minor and major surgical procedures in US adults. JAMA Surg 2017; 152 (06) e170504
  • 6 Mobbs RJ, Sivabalan P, Li J. Minimally invasive surgery compared to open spinal fusion for the treatment of degenerative lumbar spine pathologies. J Clin Neurosci 2012; 19 (06) 829-835
  • 7 Andersen MH, Mathisen L, Oyen O. , et al. Postoperative pain and convalescence in living kidney donors-laparoscopic versus open donor nephrectomy: a randomized study. Am J Transplant 2006; 6 (06) 1438-1443
  • 8 Harel M, Herbst KW, Silvis R, Makari JH, Ferrer FA, Kim C. Objective pain assessment after ureteral reimplantation: comparison of open versus robotic approach. J Pediatr Urol 2015; 11 (02) 82.e1-82.e8
  • 9 Ransom ER, Chiu AG. Prevention and management of complications in intracranial endoscopic skull base surgery. Otolaryngol Clin North Am 2010; 43 (04) 875-895
  • 10 Tien DA, Stokken JK, Recinos PF, Woodard TD, Sindwani R. Comprehensive postoperative management after endoscopic skull base surgery. Otolaryngol Clin North Am 2016; 49 (01) 253-263
  • 11 Roxbury CR, Lobo BC, Kshettry VR. , et al. Perioperative management in endoscopic endonasal skull-base surgery: a survey of the North American Skull Base Society. Int Forum Allergy Rhinol 2018; 8 (05) 631-640
  • 12 Wannemuehler TJ, Rabbani CC, Burgeson JE. , et al. Survey of endoscopic skull base surgery practice patterns among otolaryngologists. Laryngoscope Investig Otolaryngol 2018; 3 (03) 143-155
  • 13 Cramer JD, Wisler B, Gouveia CJ. Opioid stewardship in otolaryngology: state of the art review. Otolaryngol Head Neck Surg 2018; 158 (05) 817-827
  • 14 Gallagher MJ, Durnford AJ, Wahab SS, Nair S, Rokade A, Mathad N. Patient-reported nasal morbidity following endoscopic endonasal skull base surgery. Br J Neurosurg 2014; 28 (05) 622-625
  • 15 Jafari A, Shen SA, Bracken DJ, Pang J, DeConde AS. Incidence and predictive factors for additional opioid prescription after endoscopic sinus surgery. Int Forum Allergy Rhinol 2018; (May): 31
  • 16 Jiang X, Orton M, Feng R. , et al. Chronic opioid usage in surgical patients in a large academic center. Ann Surg 2017; 265 (04) 722-727
  • 17 Kalkman CJ, Visser K, Moen J, Bonsel GJ, Grobbee DE, Moons KG. Preoperative prediction of severe postoperative pain. Pain 2003; 105 (03) 415-423
  • 18 Hartwig M, Allvin R, Bäckström R, Stenberg E. Factors associated with increased experience of postoperative pain after laparoscopic gastric bypass surgery. Obes Surg 2017; 27 (07) 1854-1858
  • 19 Clarke H, Soneji N, Ko DT, Yun L, Wijeysundera DN. Rates and risk factors for prolonged opioid use after major surgery: population based cohort study. BMJ 2014; 348: g1251
  • 20 Ip HY, Abrishami A, Peng PW, Wong J, Chung F. Predictors of postoperative pain and analgesic consumption: a qualitative systematic review. Anesthesiology 2009; 111 (03) 657-677
  • 21 Campbell G, Nielsen S, Bruno R. , et al. The Pain and Opioids IN Treatment study: characteristics of a cohort using opioids to manage chronic non-cancer pain. Pain 2015; 156 (02) 231-242
  • 22 Schoenfeld AJ, Nwosu K, Jiang W. , et al. Risk factors for prolonged opioid use following spine surgery, and the association with surgical intensity, among opioid-naive patients. J Bone Joint Surg Am 2017; 99 (15) 1247-1252
  • 23 Carroll I, Barelka P, Wang CK. , et al. A pilot cohort study of the determinants of longitudinal opioid use after surgery. Anesth Analg 2012; 115 (03) 694-702
  • 24 Goesling J, Henry MJ, Moser SE. , et al. Symptoms of depression are associated with opioid use regardless of pain severity and physical functioning among treatment-seeking patients with chronic pain. J Pain 2015; 16 (09) 844-851
  • 25 Wasan AD, Michna E, Edwards RR. , et al. Psychiatric comorbidity is associated prospectively with diminished opioid analgesia and increased opioid misuse in patients with chronic low back pain. Anesthesiology 2015; 123 (04) 861-872
  • 26 Hadlandsmyth K, Vander Weg MW, McCoy KD, Mosher HJ, Vaughan-Sarrazin MS, Lund BC. Risk for prolonged opioid use following total knee arthroplasty in veterans. J Arthroplasty 2018; 33 (01) 119-123
  • 27 Gil JA, Gunaseelan V, DeFroda SF, Brummett CM, Bedi A, Waljee JF. Risk of prolonged opioid use among opioid-naïve patients after common shoulder arthroscopy procedures. Am J Sports Med 2019; 47 (05) 1043-1050
  • 28 Waljee JF, Zhong L, Hou H, Sears E, Brummett C, Chung KC. The use of opioid analgesics following common upper extremity surgical procedures: a national, population-based study. Plast Reconstr Surg 2016; 137 (02) 355e-364e
  • 29 Wang L, Guyatt GH, Kennedy SA. , et al. Predictors of persistent pain after breast cancer surgery: a systematic review and meta-analysis of observational studies. CMAJ 2016; 188 (14) E352-E361
  • 30 Johnson SP, Chung KC, Zhong L. , et al. Risk of prolonged opioid use among opioid-naïve patients following common hand surgery procedures. J Hand Surg Am 2016; 41 (10) 947-957.e3
  • 31 Trang T, Al-Hasani R, Salvemini D, Salter MW, Gutstein H, Cahill CM. Pain and poppies: the good, the bad, and the ugly of opioid analgesics. J Neurosci 2015; 35 (41) 13879-13888
  • 32 Kim YR, Shim HG, Kim CE, Kim SJ. The effect of µ-opioid receptor activation on GABAergic neurons in the spinal dorsal horn. Korean J Physiol Pharmacol 2018; 22 (04) 419-425
  • 33 Smith DH, Kuntz J, DeBar L. , et al. A qualitative study to develop materials educating patients about opioid use before and after total hip or total knee arthroplasty. J Opioid Manag 2018; 14 (03) 183-190