Among 25,076 patients undergoing parotidectomy, opioid prescribing decreased while nonopioid prescribing increased following publication of the 2021 clinical practice guidelines from the American Academy of Otolaryngology–Head and Neck Surgery, according to a retrospective analysis of US health care data.
Researchers evaluated prescribing trends using the TriNetX database across 80 US health care organizations from January 2013 through December 2023 in a study published in OTO Open. The analysis included 25,076 adult patients who underwent parotidectomy and received opioid or non-opioid analgesic prescriptions within 1 to 5 days following surgery.
Overall, 46% of patients were prescribed opioid medications postoperatively, 7% received only nonopioid medications, and 47% did not receive an opioid prescription. Interrupted time series analysis using 3-month intervals assessed changes before and after guideline publication in April 2021.
Following guideline release, opioid prescribing decreased by 7.44% immediately and continued to decline by 0.20% every 3 months. In contrast, nonopioid prescribing increased by 3.73% immediately and continued to rise by 0.12% every 3 months. Comparisons before and after guideline implementation showed statistically significant differences for both prescribing patterns.
The study used deidentified electronic health record data and interrupted time series analysis, a method previously validated in population-based studies. The researchers assessed whether prescriptions were issued, rather than dose, duration, or consumption. Patients with free flap reconstruction were excluded.
The researchers noted that opioid prescribing trends had begun to decline prior to guideline publication potentially reflecting earlier efforts to reduce prescribing or broader policy changes. Decreases in opioid prescribing and increases in nonopioid prescribing were sustained during the postpublication period.
Limitations included the inability to capture over-the-counter medication use, as well as lack of data on dosage, duration, or total opioid consumption. The use of electronic health record coding may introduce bias, and the study design does not allow determination of a causal relationship between guideline publication and prescribing patterns.
“An immediate reduction in opioid prescribing was identified for parotidectomy, and this change was sustained,” wrote lead study author Robert E. Africa MD, of the Department of Otolaryngology–Head and Neck Surgery at the University of Texas Medical Branch, and colleagues.
The authors reported no conflicts of interest.
Source: OTO Open
