Opioid prescribing after thyroid and parathyroid surgery: A survey of North American surgeons

OBJECTIVES: Opioid overprescribing remains an issue following thyroid and parathyroid surgery (TPS). We performed a cross-sectional survey study to describe opioid prescribing trends of otolaryngology-head and neck surgeons across North America. METHODS: We performed a cross-sectional survey study of otolaryngology-head and neck surgeons who are members of the Canadian Society of Otolaryngology-Head and Neck Surgery (CSO) or the American Head and Neck Society (AHNS). The voluntary 20-item online survey addressed surgeon analgesia practices for TPS and was distributed from February 2023-July 2024. Statistical analysis included descriptive methods, multivariable logistic regression, and Chi-square testing. RESULTS: Overall, 153 surgeons completed the survey (response rate: 22.6 %) and of these surgeons, most were Canadian, fellowship-trained, and practicing for 0-10 years. Most surgeons (73 %) rated postoperative patient pain as 3-5/10. Over 75 % of surgeons prescribed opioids for inpatient thyroid surgery with early-career surgeons more likely to prescribe opioids and US surgeons were less likely to prescribe opioids. Oxycodone was commonly prescribed by US surgeons and Canadian surgeons preferred codeine. Canadian surgeons were likelier to prescribe opioids, especially ≥20 opioid tabs, when compared to US surgeons. Almost 50 % of surgeons prescribed 10-19 opioid tabs despite predicting that postoperative patients likely only use 0-10 opioid tabs. CONCLUSIONS: Otolaryngology-head and neck surgeons routinely prescribe opioids for TPS despite identifying that patients only consume a fraction of their opioid prescription. Standardization of opioid prescribing and promotion of multimodal analgesia practices are needed to reduce opioid overprescription.