Narcotic Free Cervical Endocrine Surgery: A Shift in Paradigm

Area of Science:

• Endocrinology
• Pain Management
• Public Health

Background:

• The opioid epidemic necessitates reducing unnecessary narcotic prescriptions.
• Ambulatory cervical endocrine surgery (CES) is a common procedure where narcotic use can be optimized.
• Patient-centered approaches are crucial for managing post-operative pain and preventing opioid misuse.

Purpose of the Study:

• To evaluate the effectiveness of a narcotic opt-in prescription system for ambulatory CES.
• To determine if empowering patients to choose whether to receive narcotics reduces overall opioid prescription rates.
• To identify predictors of narcotic requests in patients undergoing CES.

Main Methods:

• A prospective study of 216 patients undergoing outpatient CES using a narcotic opt-in program.
• Data collected included patient demographics, procedure details, and post-operative pain scores.
• Statistical analysis, including univariate and multivariate analyses, was used to identify predictors of narcotic requests and compare results to a historical control group.

Main Results:

• Only 4% of patients requested narcotic prescriptions at discharge, a 96.6% reduction in prescribed narcotic tablets compared to the previous paradigm.
• There was a 98% reduction in unconsumed narcotic tablets.
• History of substance abuse and longer incision length were significant predictors for narcotic requests.

Conclusions:

• An opt-in prescription system for ambulatory CES effectively reduces narcotic prescribing.
• Empowering patients to decide on narcotic use leads to significant decreases in opioid prescriptions and waste.
• While certain factors predict need, the majority of patients can be managed with non-narcotic analgesics like acetaminophen.