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Multicenter Study
. 2017 Jul;24(7):1951-1957.
doi: 10.1245/s10434-017-5781-y. Epub 2017 Feb 3.

Optimizing Outpatient Pain Management After Thyroid and Parathyroid Surgery: A Two-Institution Experience

Irene Lou  1   2 , Todd B Chennell  2 , Sarah C Schaefer  1 , Herbert Chen  1   3 , Rebecca S Sippel  1 , Courtney Balentine  1   3 , David F Schneider  1 , Jacob Moalem  4
Affiliations
Multicenter Study

Optimizing Outpatient Pain Management After Thyroid and Parathyroid Surgery: A Two-Institution Experience

Irene Lou et al. Ann Surg Oncol. 2017 Jul.

Abstract

Background: Thyroidectomy and parathyroidectomy are the most commonly performed endocrine operations, and are increasingly being completed on a same-day basis; however, few data exist regarding the outpatient postoperative pain requirement of these patients. We aimed to describe the outpatient narcotic medication needs for patients undergoing thyroid and parathyroid surgery, and to identify predictors of higher requirement.

Method: We examined patients undergoing thyroid and parathyroid surgery at two large academic institutions from 1 January-30 May 2014. Prospective data were collected on pain scores and the oral morphine equivalents (OMEQs) taken by these patients by their postoperative visit.

Results: Overall, 313 adult patients underwent thyroidectomy or parathyroidectomy during the study period; 83% of patients took ten or fewer OMEQs, and 93% took 20 or fewer OMEQs. Patients who took more than ten OMEQs were younger (p < 0.001) and reported significantly higher overall mean pain scores at their postoperative visit (p < 0.001) than patients who took fewer than ten OMEQs. A multivariate model was constructed on pre- and intraoperative factors that may predict use of more than ten OMEQs postoperatively. Age <45 years (p = 0.002), previous narcotic use (p = 0.037), and whether parathyroid or thyroid surgery was performed (p = 0.003) independently predicted the use of more than ten OMEQs after surgery. A subgroup analysis was then performed on thyroidectomy-only patients.

Conclusion: Overall, 93% of patients undergoing thyroidectomy and parathyroidectomy require 20 or fewer OMEQs by their postoperative visit. We therefore recommend these patients be discharged with 20 OMEQs, both to minimize waste and increase patient safety.

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Conflict of interest statement

Conflicts of Interest

For the remaining authors, none are declared.

Figures

Figure 1
Figure 1
Distribution of outpatient narcotic pain medication utilization at post-operative visit for thyroid and parathyroid surgery patients, reference lines drawn at 20 oral morphine equivalents
Figure 2
Figure 2
Patient reasons for taking narcotic pain medication after thyroid and parathyroid surgery A. all patients B. Patients who took ≥ 10 morphine equivalents, insert shows percentage distributions by select variable of the patients who required ≥ 10 MEQ
Figure 3
Figure 3
Distribution of select variables with respect to morphine equivalents
See this image and copyright information in PMC

References

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