A Quality Improvement Initiative to Reduce Opioid Use Following Routine Thyroid and Parathyroid Surgery.

Abstract

Objective: Evaluate the postoperative pain management of patients at a single institution following routine thyroid and parathyroid surgery and compare patient opioid use before and after a practice wide quality improvement change.

Study design: Retrospective chart review with prospective survey administration.

Setting: University of New Mexico Hospital.

Methods: A standardized perioperative pain management protocol was implemented for patients undergoing routine thyroid or parathyroid surgery. Quality assurance surveys about pain and medication use following surgery were given to patients treated after the standardized protocol was introduced. Univariate and multivariate analysis was performed. Descriptive statistics and qualitative thematic analysis of survey responses were used to analyze survey results.

Results: A standardized pain management routine reduced opioid prescriptions by 46.6% for routine thyroid and parathyroid surgery patients (20.2% vs 11.0%, P < .01). On multivariate logistic regression, receiving education about pain at discharge (OR 0.37, P < 0.05) and older age (OR 0.97, P < .01) were associated with fewer opioid prescriptions while anxiety (OR 2.77, P < .05) and drain placement (4.61, P < .001) were associated with more opioid prescriptions. About half of surveyed patients completed at least one postoperative questionnaire, and most patients complained of headache, fatigue, or sore throat as opposed to pain at the surgical site.

Conclusion: Standardized counseling about postoperative pain, including clear expectations and adjunctive measures, reduces the need for postoperative opioid prescriptions in patients undergoing routine thyroid and parathyroid surgery.