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


METHODS
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.


CONCLUSIONS
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.
Section of Endocrine Surgery, Department of Surgery, University of Wisconsin, Madison, WI, USA.|Department of Surgery, University of Rochester, Rochester, NY, USA.
Irene
I
Lou
Department of Surgery, University of Rochester, Rochester, NY, USA.
Todd B
TB
Chennell
Section of Endocrine Surgery, Department of Surgery, University of Wisconsin, Madison, WI, USA.
Sarah C
SC
Schaefer
Section of Endocrine Surgery, Department of Surgery, University of Wisconsin, Madison, WI, USA.|Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
Herbert
H
Chen
Section of Endocrine Surgery, Department of Surgery, University of Wisconsin, Madison, WI, USA.
Rebecca S
RS
Sippel
Section of Endocrine Surgery, Department of Surgery, University of Wisconsin, Madison, WI, USA.|Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
Courtney
C
Balentine
Section of Endocrine Surgery, Department of Surgery, University of Wisconsin, Madison, WI, USA.
David F
DF
Schneider
Department of Surgery, University of Rochester, Rochester, NY, USA. Jacob_Moalem@URMC.Rochester.edu.
Jacob
J
Moalem
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000627:therapeutic use*; D010045:Outpatients; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D059408:Pain Management / Q000592:standards*; D010282:Parathyroid Neoplasms / Q000473:pathology / Q000601:surgery*; D016105:Parathyroidectomy / Q000009:adverse effects*; D061214:Patient Safety; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D013964:Thyroid Neoplasms / Q000473:pathology / Q000601:surgery*; D013965:Thyroidectomy / Q000009:adverse effects*; D055815:Young Adult
D000701:Analgesics, Opioid; D009020:Morphine