• Alaa Sada, Daniel S Ubl, Cornelius A Thiels, Patricia A Cronin, Benzon M Dy, Melanie L Lyden, Geoffrey B Thompson, Travis J McKenzie, and Elizabeth B Habermann.
• Department Of Surgery, Mayo Clinic, Rochester, Minnesota; Mayo Clinic, Surgical Outcomes Program, Robert D and Patricia E Kern Center for The Science of Health Care Delivery, Rochester, Minnesota.
• J. Surg. Res. 2020 Jan 1; 245: 107-114.

BackgroundTo help control opioid overprescription, we conducted a large institutional, 3-site initiative to provide discharge prescribing guidelines for different procedures. Our aim is to refine institutional guidelines for parathyroidectomy.MethodsPatients undergoing parathyroidectomy completed a 28-question survey about opioid consumption. Discharge opioid prescription amounts were converted into morphine milligram equivalents (MMEs) and reported as median and interquartile range (IQR). Consumption was dichotomized into top quartile MME users (Q4) versus standard users (Q1, Q3). Univariate analysis compared opioid consumption.ResultsA total of 91 patients were included; 90% were opioid-naive. While the median prescribed was 75 (IQR 75, 150) MME, the median consumed was 0 (IQR 0, 20). Top users reported higher pain scores [median (IQR): 2 (2, 4)] compared to standard users [1 (0, 3), P = 0.01]. However, there was no difference in opioid consumption between unilateral neck exploration, bilateral exploration, or thyroidectomy and parathyroidectomy, P = 0.11. There was no difference in opioid consumption by age, sex, or BMI (all P > 0.05). Of those receiving a prescription, 94.6% had left-over opioids at the time of survey, resulting in 82% of prescribed opioids being unused.ConclusionsOver half of patients undergoing parathyroidectomy did not consume any opioid, and very few needed more than 2 d of opioid. Moreover, most patients did not dispose the unused opioids, which put these pills at risk of diversion and misuse. Surgical approach did not change consumption, illustrating that these guidelines are applicable to thyroidectomy given the similarity between techniques. We recommend prescribing nonopioid analgesics for patients undergoing parathyroidectomy.Copyright © 2019 Elsevier Inc. All rights reserved.

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