Independent Factors Associated With Opioid Refills After Inpatient Otolaryngology–Head and Neck Surgery

Importance Persistent opioid use after otolaryngology–head and neck surgery (OHNS) is concerning. However, evidence-based guidelines for managing opioid refill prescriptions within 90 days after discharge, a critical period for the transition from acute to persistent opioid use, are lacking. Objective To identify perioperative risk factors associated with opioid refills at 1 to 30, 31 to 60, and 61 to 90 days after OHNS procedures. Design, Setting, Participants This cohort study used opioid prescription data from a large academic medical center. The study included adult patients, regardless of opioid-naive status, who underwent inpatient OHNS procedures and were discharged between January 2017 and December 2023. Exposure OHNS with a postoperative hospital stay of at least 1 day. Main Outcomes and Measures The primary outcomes were opioid refills at 1 to 30, 31 to 60, and 61 to 90 days after discharge. Results Among 4132 adult patients, the median (IQR) age was 62 (49-72) years, and 1870 (45.3%) were female. From 2017 to 2023, despite a substantial reduction in the total oral morphine equivalents (OME) of discharge opioid prescriptions after OHNS procedures, opioid refill rates remained unchanged. In multiple logistic regression analysis, underprescription (adjusted odds ratio [AOR], 1.60 [95% CI, 1.24-2.06]) and overprescription (AOR, 1.58 [95% CI, 1.29-1.95]) of discharge opioid daily doses (defined as ≥7.5 OME lower or higher than the patient’s inpatient opioid consumption during the last 24 hours before discharge), compared with a matched prescription, were associated with increased odds of refills within 30 days of discharge. Overprescription was also associated with increased odds of refills at 31 to 60 days (AOR, 1.34 [95% CI, 1.03-1.75]). Other factors associated with increased odds of refills at various time points included preoperative use of opioids, benzodiazepines, and cannabis; higher postsurgical pain levels; receiving a prior refill; and receiving an opioid prescription despite not using any inpatient opioids during the last 24 hours of hospitalization. Conclusion and Relevance This cohort study identified independent perioperative risk factors for opioid refills after inpatient OHNS procedures and proposes an evidence-based strategy to reduce refill risk.