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

Irene Lou, Todd B. Chennell, Sarah C. Schaefer, Herbert Chen, Rebecca S. Sippel, Courtney Balentine, David F. Schneider, Jacob Moalem

Research output: Contribution to journalArticle

12 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)1951-1957
Number of pages7
JournalAnnals of Surgical Oncology
Volume24
Issue number7
DOIs
StatePublished - Jul 1 2017
Externally publishedYes

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Pain Management
Thyroid Gland
Outpatients
Morphine
Thyroidectomy
Parathyroidectomy
Narcotics
Pain
Patient Safety
Postoperative Pain

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Optimizing Outpatient Pain Management After Thyroid and Parathyroid Surgery : A Two-Institution Experience. / Lou, Irene; Chennell, Todd B.; Schaefer, Sarah C.; Chen, Herbert; Sippel, Rebecca S.; Balentine, Courtney; Schneider, David F.; Moalem, Jacob.

In: Annals of Surgical Oncology, Vol. 24, No. 7, 01.07.2017, p. 1951-1957.

Research output: Contribution to journalArticle

Lou, I, Chennell, TB, Schaefer, SC, Chen, H, Sippel, RS, Balentine, C, Schneider, DF & Moalem, J 2017, 'Optimizing Outpatient Pain Management After Thyroid and Parathyroid Surgery: A Two-Institution Experience', Annals of Surgical Oncology, vol. 24, no. 7, pp. 1951-1957. https://doi.org/10.1245/s10434-017-5781-y
Lou, Irene ; Chennell, Todd B. ; Schaefer, Sarah C. ; Chen, Herbert ; Sippel, Rebecca S. ; Balentine, Courtney ; Schneider, David F. ; Moalem, Jacob. / Optimizing Outpatient Pain Management After Thyroid and Parathyroid Surgery : A Two-Institution Experience. In: Annals of Surgical Oncology. 2017 ; Vol. 24, No. 7. pp. 1951-1957.
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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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AU - Lou, Irene

AU - Chennell, Todd B.

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AU - Chen, Herbert

AU - Sippel, Rebecca S.

AU - Balentine, Courtney

AU - Schneider, David F.

AU - Moalem, Jacob

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N2 - 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.

AB - 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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