Variability in opioid prescribing for children undergoing ambulatory surgery in the United States

Objectives: I undertook to determine benchmarks and variability for the surgical times associated with ambulatory otolaryngological procedures in the United States. Methods: I examined the 2006 release of the National Survey of Ambulatory Surgery and extracted all cases of otolaryngological surgery in which one, and only one, otolaryngological procedure was performed. The mean surgical times and operating room times were determined for each procedure that met reliability criteria for their estimates. A secondary analysis was computed for tonsillectomy and for tonsillectomy plus adenoidectomy according to a patient age of greater than 12 years. Results: An estimated 1.68 ± 0.23 million otolaryngological procedures were analyzed as solitary procedures, including 507,000 cases of myringotomy with ventilation tube placement, 136,000 cases of tonsillectomy, and 429,000 cases of tonsillectomy plus adenoidectomy. The mean (±SE) surgical times were 8.0 ± 0.5, 23.9 ± 1.8, and 20.3 ± 0.8 minutes, respectively. The total operating room times were 17.6 ± 0.9, 48.2 ± 2.0, and 40.7 ± 1.1 minutes, respectively. Septoplasty with turbinectomy was the most common rhinologic procedure performed (48,000 cases analyzed) and had surgical and operating room times of 49.6 ± 4.78 and 79.8 ± 5.8 minutes, respectively. The surgical times for tonsillectomy and tonsillectomy plus adenoidectomy did not differ significantly in magnitude according to standard age cutoffs, although the operating room time was slightly (11.7 minutes) longer for tonsillectomy in patients more than 12 years of age (p = 0.034). Conclusions: The surgical times for the performance of the most common otolaryngological ambulatory procedures are remarkably consistent in the United States. Given the volume and consistency of these surgical procedures, they are ideal candidates for studies of cost and efficiency.

Download Full-text

Postoperative Opioid Prescribing Practice in Foot and Ankle Surgery

Journal of the American Podiatric Medical Association ◽

10.7547/20-223 ◽

2021 ◽

Author(s):

Brandon M Brooks ◽

Bradley M Brooks ◽

Brady M Brooks ◽

Adam E Fleischer ◽

Robert G Smith ◽

...

Keyword(s):

United States ◽

Online Survey ◽

The United States ◽

Practice Variation ◽

Foot And Ankle ◽

Linear Regression Models ◽

Time Of Surgery ◽

Opioid Prescribing ◽

Ankle Surgery ◽

Prescribing Practice

Background: Clinicians, governmental agencies, patients, and pharmaceutical companies all contribute to the United States' opioid epidemic. These same stakeholders can make meaningful contributions to resolve the epidemic by identifying ineffective habits and encouraging change. The purpose of this study was to determine if postoperative opioid prescribing practice variation exists in foot and ankle surgery. We also aimed to identify if demographic characteristics of podiatric foot and ankle surgeons were associated with their postoperative opioid prescribing practices. Methods: We administered an open, voluntary, anonymous, online questionnaire distributed on the internet via Qualtrics, an online survey platform. The questionnaire consisted of six foot and ankle surgery scenarios followed by a demographics section. We invited Podiatric foot and ankle surgeons practicing in the United States to complete the questionnaire via email from the American Podiatric Medical Association's membership list. Respondents selected the postoperative opioid(s) that they would prescribe at the time of surgery, as well as the dose, frequency, and number of "pills" (dosage units). We developed multiple linear regression models to identify associations between prescriber characteristics and two measures of opioid quantity: dosage units and MME. Results: Eight hundred and sixty podiatric foot and ankle surgeons completed the survey. The median number of dosage units never exceeded 30 regardless of the foot and ankle surgery. Years in practice correlated with reduction in opioid dosage units prescribed at the time of surgery. Conclusions: Postoperative opioid prescribing practice variation exists in foot and ankle surgery. In comparison to the orthopedic community, podiatric foot and ankle surgeons prescribe approximately 25% fewer opioids at the time of surgery than orthopedic foot and ankle surgeons. Further research is warranted to determine if additional education is needed for young surgeons.

Download Full-text