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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Funding
Irene Lou is currently receiving Grant support from 5T32CA090217-15, and David F. Schneider is currently receiving Grant support from NIH UL1TR000427 and NIH KL2TR000428.
Disclosure
Todd B. Chennell, Sarah Schaefer, Herbert Chen, Rebecca S. Sippel, Courtney Balentine, and Jacob Moalem declare no conflicts of interest.
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Lou, I., Chennell, T.B., Schaefer, S.C. et al. Optimizing Outpatient Pain Management After Thyroid and Parathyroid Surgery: A Two-Institution Experience. Ann Surg Oncol 24, 1951–1957 (2017). https://doi.org/10.1245/s10434-017-5781-y
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DOI: https://doi.org/10.1245/s10434-017-5781-y