Incidence and Predictive Factors for Additional Opioid Prescription after Endoscopic Skull-Base Surgery

BACKGROUND: Excessive postoperative opioid prescription is a source of prescription diversion in the United States opioid crisis and may contribute to chronic opioid use. Efficient prescription by the surgeon can mitigate opioid abuse and improve postoperative pain control. In this study we sought to better characterize the incidence and predictive baseline characteristics associated with the need for additional opioid prescription after endoscopic sinus surgery (ESS) for chronic rhinosinusitis. METHODS: A retrospective review was performed on subjects undergoing ambulatory ESS between November 2016 and August 2017. The medical and Controlled Substance Utilization Review and Evaluation System (CURES) records were reviewed. Uni- and multivariable logistic regressions were performed to evaluate factors associated with additional opioid prescription within 60 days of surgery. RESULTS: A total of 121 patients were included. Additional prescriptions were seen in 22 patients (18%). Surgical factors, including sinuses operated, septoplasty, revision, or extended procedure (Draf IIB/III), were not associated with additional prescription. On multivariate logistic regression, preoperative opioid use (odds ratio [OR], 23.45; 95% CI, 1.52-362.63), greater number of prescribed tablets (OR, 1.13; 95% CI, 1.01-1.26), and lower preoperative health status (ASA score) (OR, 11.21; 95% CI, 1.49-84.30) were associated with additional prescription (p < 0.05). CONCLUSION: A need for extension of postoperative opioid pain control is not uncommon after ESS. Patient baseline clinical characteristics are predictive of a need for re-prescription of opioids. Surgical extent is not associated with need for prolonged postoperative opioid pain management.