Global variation in opioid prescribing after head and neck reconstruction: understanding the United States' outlier status.

Abstract

W. Edwards Deming, widely acknowledged as the Father of Quality Management, observed that “Uncontrolled variation is the enemy of quality” and much of the progress in improving the quality of patient care can be attributed to standardization (1). Yet few aspects of healthcare exhibit more global variation than the administration of opioids for head and neck cancer. For example, one study of pain management practices after major head and neck surgery found that 87% of American patients received opioids in contrast to <1% in Hong Kong (2). The United States’ (U.S.) outlier status in opioid prescribing behavior is well-documented (3), and these patterns might reflect not only different cultural perceptions but also different beliefs regarding the safety, efficacy, and risks of opioid medications (4).