Opioid Prescribing Patterns After Head and Neck Surgery

Objective Postoperative prescription narcotics increase access to opioids and associated abuse among patients, family, and acquaintances. Judicious opioid stewardship is required. Best practice questions remain for larger head and neck surgeries. We aim to review opioid utilization patterns in an urban patient population to identify patients at risk for poor postoperative pain control. Study Design Case series with planned chart review for patients undergoing head and neck surgery (2015-2018). Setting Single urban hospital. Methods Outcome measures included postoperative phone calls and emergency room visits as markers for inadequate pain control. Age, sex, race, body mass index (BMI), smoking status, comorbidities, prior narcotic filling behavior, surgery type, and duration were evaluated as potential risk factors for pain control. Chi-square and Wilcoxon tests were used for group comparisons. Results In total, 215 patients met inclusion criteria: male (22%), white/Hispanic (47%), and African American (44%). Median BMI was 31.6 kg/m2; median age was 52 years. Surgeries included total thyroidectomy (41%), hemithyroidectomy (27%), and parathyroidectomy (15%). The 23-hour observation patients (n = 175, 81%) had a median of 20 morphine milligram equivalents (MMEs). Sixteen patients experienced inadequate pain control. Female sex ( P = .03), younger age ( P = .02), current smoker ( P = .03), and higher inpatient MME ( P = .006) were associated with inadequate pain control. Conclusion Female sex, younger age, smokers, and high inpatient opioid dose requirements are associated with inadequately controlled pain. These patients may benefit from additional education, earlier postoperative visits, and a more comprehensive nonopioid regimen.

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Current Advances in Robotics for Head and Neck Surgery—A Systematic Review

Cancers ◽

10.3390/cancers13061398 ◽

2021 ◽

Vol 13 (6) ◽

pp. 1398

Author(s):

Felix Boehm ◽

Rene Graesslin ◽

Marie-Nicole Theodoraki ◽

Leon Schild ◽

Jens Greve ◽

...

Keyword(s):

Systematic Review ◽

Head And Neck ◽

Large Scale ◽

Case Series ◽

Clinical Effectiveness ◽

Neck Surgery ◽

Head And Neck Surgery ◽

Daily Routine ◽

Surgical Robots ◽

Standard Procedures

Background. In the past few years, surgical robots have recently entered the medical field, particularly in urology, gynecology, and general surgery. However, the clinical effectiveness and safety of robot-assisted surgery (RAS) in the field of head and neck surgery has not been clearly established. In this review, we evaluate to what extent RAS can potentially be applied in head and neck surgery, in which fields it is already daily routine and what advantages can be seen in comparison to conventional surgery. Data sources. For this purpose, we conducted a systematic review of trials published between 2000 and 2021, as well as currently ongoing trials registered in clinicaltrials.gov. The results were structured according to anatomical regions, for the topics “Costs,” “current clinical trials,” and “robotic research” we added separate sections for the sake of clarity. Results. Our findings show a lack of large-scale systematic randomized trials on the use of robots in head and neck surgery. Most studies include small case series or lack a control arm which enables a comparison with established standard procedures. Conclusion. The question of financial reimbursement is still not answered and the systems on the market still require some specific improvements for the use in head and neck surgery.

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Efeito dos gabapentinoides no controle da dor pós-operatória em pacientes submetidos à cirurgia de cabeça e pescoço / Effect of gabapentinoids on postoperative pain control in patients undergoing head and neck surgery

Brazilian Journal of Health Review ◽

10.34119/bjhrv4n2-092 ◽

2021 ◽

Vol 4 (2) ◽

pp. 5170-5181

Author(s):

Mirlane Guimaraes de Melo Cardoso ◽

José Eduardo Martins Adorno ◽

Hugo Arão Costa Brasil Filho ◽

Mewryane Câmara Brandão Ramos ◽

Ivandete Coelho Pereira Pimentel ◽

...

Keyword(s):

Postoperative Pain ◽

Head And Neck ◽

Pain Control ◽

Neck Surgery ◽

Head And Neck Surgery ◽

Postoperative Pain Control

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Does Surgical Volume and Complexity Affect Cost and Mortality in Otolaryngology–Head and Neck Surgery?

Otolaryngology ◽

10.1177/0194599819861524 ◽

2019 ◽

Vol 161 (4) ◽

pp. 629-634 ◽

Cited By ~ 2

Author(s):

Andrew J. Redmann ◽

Sonia N. Yuen ◽

Douglas VonAllmen ◽

Adam Rothstein ◽

Alice Tang ◽

...

Keyword(s):

Head And Neck ◽

Case Series ◽

Neck Surgery ◽

Mortality Rates ◽

Head And Neck Surgery ◽

Additional Case ◽

Complication Rates ◽

Total Cost ◽

Case Complexity ◽

Point Increase

Objectives (1) To evaluate whether admission volume and case complexity are associated with mortality rates and (2) evaluate whether admission volume and case complexity are associated with cost per admission. Study Design Retrospective case series. Setting Tertiary academic hospital. Subjects and Methods The Vizient database was queried for inpatient admissions between July 2015 and March 2017 to an otolaryngology–head and neck surgery service. Data collected included admission volume, length of stay, intensive care unit (ICU) status, complication rates, case mix index (CMI), and cost data. Regression analysis was performed to evaluate the relationship between cost, CMI, admission volume, and mortality rate. Results In total, 338 hospitals provided data for analysis. Mean hospital admission volume was 182 (range, 1-1284), and mean CMI was 1.69 (range, 0.66-6.0). A 1-point increase in hospital average CMI was associated with a 40% increase in odds for high mortality. Admission volume was associated with lower mortality, with 1% lower odds for each additional case. A 1-point increase in CMI produces a $4624 higher total cost per case (95% confidence interval, $4550-$4700), and for each additional case, total cost per case increased by $6. Conclusion For otolaryngology inpatient services at US academic medical centers, increasing admission volume is associated with decreased mortality rates, even after controlling for CMI and complication rates. Increasing CMI levels have an anticipated correlation with higher total costs per case, but admission volume is unexpectedly associated with a significant increase in average cost per case.

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Honey as a Treatment in Otorhinolaryngology: A Review by Subspecialty

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489418815188 ◽

2018 ◽

Vol 128 (3) ◽

pp. 193-207 ◽

Cited By ~ 2

Author(s):

Theresa Tharakan ◽

John Bent ◽

Raluca Tavaluc

Keyword(s):

Head And Neck ◽

Reconstructive Surgery ◽

Case Series ◽

Neck Surgery ◽

Head And Neck Surgery ◽

Cochrane Central Register ◽

Randomized Control Trials ◽

Randomized Control ◽

Level 1 ◽

Meta Analyses

Objectives: To provide an up-to-date review of honey’s effectiveness and potential applications in otorhinolaryngology. Methods: A literature search of the online databases PubMed, EMBASE, and Cochrane Central Register of Controlled Trials was conducted. Results: Sixty-three studies were identified within head and neck surgery (n = 23, 36%); pediatric otolaryngology (n = 18, 29%); rhinology, sinus, and skull base surgery (n = 11, 17%); otology (n = 6, 10%), facial plastic and reconstructive surgery (n = 3, 5%); and laryngology (n = 2, 3%). Studies included 6 meta-analyses, 44 randomized control trials, 5 case reports, and 8 animal models or in vitro studies. Of 55 clinical studies, 50 reported Level 1 evidence (prospective randomized control trials), and 5 reported Level 4 evidence (case series). The evidence level by subspecialty was: head and neck surgery (Level 1 n = 23), pediatrics (Level 1 n = 18), rhinology (Level 1 n = 7, level 4 n = 1), otology (Level 1 n = 1, Level 4 n = 3), facial plastics and reconstructive surgery (Level 4 n = 1), and laryngology (Level 1 n = 2). Conclusions: Honey can be used for a variety of otolaryngology conditions. The highest quality meta-analyses support oral honey for prevention and treatment of oral mucositis in cancer patients, cough associated with upper respiratory infection in children, and pain control after tonsillectomy. Further research will likely justify broader applications.

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Aspiration pneumonia in patients underwent head and neck surgery. A case series

ACTUALIDAD MEDICA ◽

10.15568/am.2017.801.or05 ◽

2017 ◽

Vol 102 (801) ◽

pp. 86-87

Author(s):

Yolanda Baca Morilla ◽

◽

Paolo Cariati ◽

Almudena Cabello Serrano ◽

Fernando Monsalve Iglesias ◽

...

Keyword(s):

Head And Neck ◽

Aspiration Pneumonia ◽

Case Series ◽

Neck Surgery ◽

Head And Neck Surgery

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Duplication of the vertebral artery: A series of four cases

Interventional Neuroradiology ◽

10.1177/1591019918783973 ◽

2018 ◽

Vol 24 (6) ◽

pp. 596-600

Author(s):

Michael Kritikos ◽

Nikhil Sharma ◽

Neda Sedora-Roman ◽

Omar Choudhri ◽

Bryan Pukenas ◽

...

Keyword(s):

Vertebral Artery ◽

Head And Neck ◽

Interventional Procedures ◽

Incidental Finding ◽

Case Series ◽

Neck Surgery ◽

Head And Neck Surgery ◽

Imaging Findings ◽

Relevant Finding ◽

Vascular Variant

Introduction Duplication of the vertebral artery (VA) is a rare vascular variant, with less than 50 reported cases in the literature. Case series We present four cases of VA duplication and discuss the imaging findings, which highlight the rarely seen VA duplication. Discussion VA duplication is generally considered to be an incidental finding. The VA is formed from the fusion of the longitudinal anastomoses that link the cervical intersegmental arteries, during the 32–40-day stage. The duplication of the VA is a clinically relevant finding for planning of head and neck surgery and neuro-interventional procedures.

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Assessment of Preoperative Functional Status Prior to Major Head and Neck Surgery: A Pilot Study

Otolaryngology ◽

10.1177/01945998211019306 ◽

2021 ◽

pp. 019459982110193

Author(s):

Ashley L. Miller ◽

Andrew J. Holcomb ◽

Anuraag S. Parikh ◽

Julianne M. Richards ◽

Vinay K. Rathi ◽

...

Keyword(s):

Length Of Stay ◽

Functional Status ◽

Head And Neck ◽

Discharge Planning ◽

Tertiary Care ◽

Case Series ◽

Neck Surgery ◽

Head And Neck Surgery ◽

Postoperative Outcomes ◽

Reconstructive Procedures

Objective To demonstrate feasibility of a recently developed preoperative assessment tool, the Vulnerable Elders Surgical Pathways and Outcomes Analysis (VESPA), to characterize the baseline functional status of patients undergoing major head and neck surgery and to examine the relationship between preoperative functional status and postoperative outcomes. Study Design Case series with planned data collection. Setting Two tertiary care academic hospitals. Methods The VESPA was administered prospectively in the preoperative setting. Data on patient demographics, ablative and reconstructive procedures, and outcomes including total length of stay, discharge disposition, delay in discharge, or complex discharge planning (delay or change in disposition) were collected via retrospective chart review. VESPA scores were calculated and risk categories were used to estimate risk of adverse postoperative outcomes using multivariate logistic regression for categorical outcomes and linear regression for continuous variables. Results Fifty-eight patients met study inclusion criteria. The mean (SD) age was 66.4 (11.9) years, and 58.4% of patients were male. Nearly one-fourth described preoperative difficulty in either a basic or instrumental activity of daily living, and 17% were classified as low functional status (ie, high risk) according to the VESPA. Low functional status did not independently predict length of stay but was associated with delayed discharge (odds ratio [OR], 5.0; 95% CI, 1.2-21.3; P = .030) and complex discharge planning (OR, 5.7; 95% CI, 1.34-24.2; P = .018). Conclusion The VESPA can identify major head and neck surgical patients with low preoperative functional status who may be at risk for delayed or complex discharge planning. These patients may benefit from enhanced preoperative counseling and more comprehensive discharge preparation.

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