Changes in Opioid Prescribing Habits for Patients Undergoing Rhinoplasty and Septoplasty

Key Points

Question  Has there been a decrease in the amount of opioids prescribed to patients following rhinoplasty and/or septoplasty since the Vermont opioid prescribing legislation took effect on July 1, 2017, and if so, are patients experiencing more postoperative pain?

Findings  In this case-control study of 80 adults, the mean number of opioid pills prescribed to patients after the Vermont opioid prescribing legislation decreased from 17.5 to 9.7, which was associated with a statistically significant decrease in the mean morphine milligram equivalents that were prescribed (130.9 to 73.2). There was no statistically significant difference in the number of postoperative telephone calls for pain, second prescriptions, or increased complaints of pain at the postoperative visit.

Meaning  Since there was no increase in patients’ complaints about postoperative pain or a need for a second prescription after surgery, the decreased amount of opioids prescribed seems sufficient for pain control.

Importance  Opioid prescriptions have increased substantially over the last 2 decades, contributing to the opioid epidemic. Physician practices and legislative changes play a key role in decreasing prescription opioid use.

Objective  To evaluate changes in opioid prescribing habits for patients undergoing rhinoplasty and/or septoplasty before and after the adoption of new opioid legislation.

Design, Setting, and Participants  This single-institution case-control study examined opioid prescribing habits for 80 patients who were undergoing rhinoplasty and septoplasty with or without turbinate reduction at the University of Vermont between March 2016 and May 2018. Patients were excluded if they underwent concomitant endoscopic sinus surgery or were younger than 14 years. Patients were divided by surgery date before or after legislative changes on July 1, 2017.

Exposures  Rhinoplasty and septoplasty with or without turbinate reduction.

Main Outcomes and Measures  Patient demographics and opioid prescriptions were recorded. Patients were evaluated if they reported pain during follow-up, called the office, or received a second prescription. The Vermont Prescription Monitoring System was queried to determine if opioid prescriptions were filled within 30 days of the procedure. The 2 groups were compared to test the hypothesis that opioid prescriptions had decreased after legislative changes.

Results  Of a total of 80 participants, the mean (SD) age in the before (15 women [37.5%]) and after (16 women [40.0%]) groups were 41.4 years and 40.6 years, respectively. There was a statistically significant decrease in the number of pills prescribed to the after group (17.5 to 9.7; P < .001) as well as a decrease in the morphine milligram equivalents that were prescribed (130.9 to 73.2; P < .001). There was no statistical difference in the number of postoperative telephone calls for pain, second prescriptions, or increased complaints of pain at the postoperative visit.

Conclusions and Relevance  Recent laws in Vermont regarding opioid prescribing were implemented in 2017 to curb the ongoing opioid epidemic. Our observations of patients undergoing septoplasties and rhinoplasties found a significant reduction in opioid prescriptions. This was not associated with an increase in patient complaints about postoperative pain or the need for a second prescription after surgery. This shows that we may safely be able to decrease the number of narcotic medications that we prescribe.

Level of Evidence  3.

Original Article

Source