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Opioid Usage and Prescribing Predictors Following Transoral Robotic Surgery for Oropharyngeal Cancer
Author(s) -
Abt Nicholas B.,
Holcomb Andrew J.,
Feng Allen L.,
Suresh Krish,
Mokhtari Tara E.,
McHugh Christopher I.,
Parikh Anuraag S.,
Faden Daniel L.,
Deschler Daniel G.,
Varvares Mark A.,
Lin Derrick T.,
Richmon Jeremy D.
Publication year - 2021
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.29276
Subject(s) - medicine , transoral robotic surgery , opioid , cancer , cohort , oncology , retrospective cohort study , stage (stratigraphy) , medical prescription , surgery , pharmacology , receptor , paleontology , biology
Objective/Hypothesis Pain management following transoral robotic surgery (TORS) varies widely. We aim to quantify opioid usage following TORS for oropharyngeal squamous cell carcinoma (OPSCC) and identify prescribing predictors. Study Design Retrospective cohort study. Methods A consecutive series of 138 patients undergoing TORS for OPSCC were reviewed from 2016 to 2019. Opioid usage (standardized to morphine milligram equivalents [MME]) was gathered for 12 months post‐surgery via prescribing record cross‐check with the Massachusetts Prescription Awareness Tool. Results Of 138 OPSCC TORS patients, 92.8% were human papillomavirus (HPV) positive. Adjuvant therapy included radiation (XRT;67.4%) and chemoradiation (cXRT;6.5%). Total MME usage from start of treatment averaged 1395.7 MMEs with 76.4% receiving three prescriptions or less. Categorical analysis showed age <65, male sex, overweight BMI, lower frailty, former smokers, HPV+, higher T stage, and BOT subsite to be associated with increased MMEs. Adjuvant therapy significantly increased MMEs (TORS+XRT:1646.2; TORS+cXRT:2385.0; TORS alone:554.7 [ P < .001]) and 12‐month opioid prescription totals (TORS+XRT:3.2; TORS+cXRT:5.5; TORS alone:1.6 [ P < .001]). Adjuvant therapy increased time to taper (total MME in TORS alone versus TORS+XRT/cXRT: 0 to 3 months:428.2 versus 845.5, 4 to 6 months:46.8 versus 541.8, 7 to 9 months:12.4 versus 178.6, 10 to 12 months:11.0 versus 4.4,[ P < .001]). Positive predictors of opioid prescribing at the 4‐ to 6‐month and 4‐ to 12‐month intervals included adjuvant therapy (odds ratio [OR]:5.56 and 4.51) and mFI‐5 score ≥3 (OR:36.67 and 31.94). Following TORS at 6‐, 9‐, and 12‐month, 15.7%, 6.6%, and 4.1% were still using opioids. Conclusions In OPSCC treated with TORS, opioid use tapers faster for surgery alone versus with adjuvant therapy. Opioid prescribing risks include adjuvant therapy and higher frailty index. Level of Evidence 4 Laryngoscope , 131:E1888–E1894, 2021