Predictive Factors for Postoperative Opioid Use in Elective Endoscopic Endonasal Skull Base Surgery

Area of Science:

• Neurosurgery
• Pain Management
• Public Health

Background:

• The opioid epidemic remains a critical public health issue, necessitating reduced opioid use in surgery.
• Factors influencing postoperative opioid consumption in neurosurgery are increasingly studied.
• Postoperative opioid use in endoscopic endonasal skull base surgery (EESBS) is not well understood.

Purpose of the Study:

• To identify demographic and surgical factors associated with postoperative opioid use in EESBS.
• To inform strategies for optimizing pain management and reducing opioid reliance in EESBS patients.

Main Methods:

• Retrospective review of 454 patients undergoing elective EESBS (January 2015 - December 2020).
• Collection and analysis of patient demographics, clinical history, and operative data.
• Multivariable linear regression to determine factors associated with opioid use at 24, 48, and 72 hours postoperatively.

Main Results:

• Younger patient age and a history of anxiety/depression significantly increased opioid use at 24, 48, and 72 hours postoperatively.
• Nasoseptal flap use was associated with increased opioid use at 24 and 48 hours.
• No significant association found for sex, migraine history, preoperative opioid use, surgery length, or surgical approach.

Conclusions:

• Patient history of anxiety/depression, younger age, and nasoseptal flap use are key factors linked to higher postoperative opioid consumption in EESBS.
• Understanding these risk factors can guide perioperative prescribing to balance effective pain control with reduced opioid use.