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J Neurol Surg B Skull Base 2020; 81(03): 301-307
DOI: 10.1055/s-0039-1692473
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Incidence and Predictive Factors for Additional Opioid Prescription after Endoscopic Skull Base Surgery

Sarek A. Shen 
1   School of Medicine, University of California San Diego, La Jolla, California, United States
,
Aria Jafari
2   Department of Surgery, Division of Otolaryngology—Head and Neck Surgery, University of California San Diego, San Diego, California, United States
,
Jesse R. Qualliotine
2   Department of Surgery, Division of Otolaryngology—Head and Neck Surgery, University of California San Diego, San Diego, California, United States
,
Adam S. DeConde
2   Department of Surgery, Division of Otolaryngology—Head and Neck Surgery, University of California San Diego, San Diego, California, United States
› Author Affiliations
Further Information

Publication History

28 February 2019

11 May 2019

Publication Date:
12 June 2019 (online)

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Abstract

Introduction Postoperative pain management and opioid use following endoscopic skull base surgery (ESBS) is not well understood. A subset of patients requires additional opioid prescription (AOP) in the postoperative period. The objective of this study is to describe the incidence of AOP, as well as evaluate patient and surgical characteristics that may predict additional pain management requirements following ESBS.

Methods A retrospective review of cases undergoing ESBS between November 2016 and August 2018 was performed. We reviewed patients' sociodemographic and clinical data, and Controlled Substance Utilization Review and Evaluation System (CURES) records. Stepwise multivariable logistic regressions were performed to evaluate the factors associated with AOP within 60 days following surgery.

Results A total of 42 patients were identified. Indications for ESBS included intracranial mass (64.2%), sinonasal malignancy (23.8%), and skull base reconstruction (9.5%). AOP were recorded in nine patients (21.4%). There were no significant differences in operative factors, including approach, lesion location, or perioperative analgesia between the two cohorts. On multivariable logistic regression, we found that younger age (odds ratio [OR]: 0.891, 95% confidence interval [CI]: 0.79–1.00, p = 0.050), comorbid depression (OR: 86.48, 95% CI: 1.40–5,379.07, p = 0.034), and preoperative opioid use (OR: 104.45, 95% CI: 1.41–7,751.10, p = 0.034) were associated with additional prescriptions postoperatively.

Conclusion The requirement for extended postoperative opioid pain control is common after ESBS. Patient demographics including age and psychosocial factors, such as depression may predict the need for AOP after ESBS. These results suggest that patient-driven factors, rather than surgical characteristics, may determine the need for prolonged pain control requirements after ESBS.

Keywords

opioid - endoscopic skull base surgery - pain management - outcomes - quality of life - prolonged opioid use

Financial Support

None.


Institutional Review Board

The study was approved by the University of California, San Diego Institutional Review Board (IRB; 161005X).


Presentation at Scientific Conference

The study was accepted for oral presentation at the North American Skull Base Society 29th Annual Meeting on Feb 17, 2019.


 

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