Li RJ, et al. - Researchers reported the differences in postoperative pain regimens between an international and domestic head and neck surgical program. Frequency of postoperative opioid orders was significantly lower from Chinese University of Hong Kong (CUHK) vs Oregon Health and Science University (OHSU) across similar major head and neck procedures. A careful examination of cultural and patient expectations of pain control, the metrics by which control is assessed, industry and economic drivers of opioid use, and alternatives to opioid pain regimens was encouraged by these results. An opportunity to counter the epidemic of opioid abuse in the US could be had via a thoughtful shift in postoperative pain protocols that deemphasize opioid use.

Methods

• Experts compared a pain management patterns after head and neck surgery in the programs at Chinese University of Hong Kong (CUHK) and Oregon Health and Science University (OHSU) with a focus on opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen or paracetamol, and anxiolytics.
• They reviewed the cases from July 1, 2013 through August 31, 2017.
• They compared the standing medication orders the day before surgery (PRE1), postoperative day 6 (POD6), and postoperative day 14 (POD14) between institutions.

Results

• As per data, they analyzed a total of 253 cases from CUHK and 567 cases from OHSU (mean [SD] age, 59.4 [14.3] and 60.1 [16.4] years, respectively).
• A significantly higher frequency of opioid orders on PRE1 (15.3% vs 1.6%; odds ratio [OR], 11.3; 95% CI, 4.09-31.10), POD6 (86.8% vs 0.4%; OR, 1653.12; 95% CI, 228.51-11,959.01), and POD14 (71.4% vs 0.8%; OR, 313.75; 95% CI, 77.12-1276.52) was seen in the patients from OHSU.
• Findings did not suggest any significant differences in acetaminophen or paracetamol, NSAID, or anxiolytic orders between institutions.
• The most significant indicator for the presence of opioid orders on POD6 (OR, 4271.10; 95% CI, 380.04-47 999.70) and POD14 (OR, 330.35; 95% CI, 79.67-1369.82) was institution.
• Along with the treating institution, multivariate analysis showed that a significant increase in likelihood of opioid orders on POD6 (OR, 4.77; 95% CI, 1.23-18.57) was indicated by PRE1 opioid orders but not POD14.
• A significant indicator of opioid orders for POD6 (95% CI, 1.49-113.10) and POD14 (95% CI, 1.17-5.03), respectively, was POD6 anxiolytic orders.