Improving Multimodal Analgesic Use After Otolaryngologic Surgery-A Single-Institution Experience of 9000 Patients.

Abstract

Objective: This study aims to assess a quality improvement intervention to decrease opiate prescriptions at discharge and improve patient access to multimodal analgesics (MMA) after otolaryngologic surgery.

Study design: Longitudinal quality improvement initiative with retrospective prescription trend review and prospective patient questionnaire collection.

Setting: An academic medical center.

Methods: Opioid, acetaminophen, and non-steroidal anti-inflammatory drug (NSAID) discharge prescriptions after otolaryngologic procedures were reviewed. Two annual department-wide workshops were carried out to review the literature on published MMA protocols and develop standardized post-operative pain medication instructions to reduce opioid use. Concurrently, a patient survey was distributed to evaluate discharge pain medication use and satisfaction with pain control.

Results: Discharge pain medications were reviewed for 9064 procedures between January 2021 and May 2024. After the interventions above, the percentage of patients receiving opioids at discharge decreased from 61.4% to 46.8% (P < .00001). Concurrently, acetaminophen and NSAID discharge prescriptions increased from 24.3% and 10.2% to 67.4% and 46.1%, respectively (both P < .00001). Among 100 patients surveyed, satisfaction with post-operative pain control was high before and after the implementation of standardized discharge instructions, even though fewer post-intervention patients received opioids at discharge (49.1% compared to 76.6% pre-intervention, P = .007). Notably, 27% of patients prescribed opioids reported not taking them and 23% reported saving unused opioids for future use.

Conclusion: Implementation of standardized post-operative pain medication instructions at discharge after otolaryngologic procedures led to a substantial decrease in opioids prescribed while maintaining patient satisfaction with post-operative pain management. A significant proportion of patients reported saving unused opioids for future use despite standardized safe disposal instructions.