Assessing Impact: Implementing an Opioid Prescription Protocol in Otolaryngology

Arielle G. Thal, Sadia Ahmed, Stanley Kim, Christina J. Yang, Qi Gao, Mona Gangar, Vikas Mehta

Research output: Contribution to journalArticlepeer-review


Objective A lack of guidance for pain control after otolaryngology surgery can lead to overprescription of opioids. We implemented a postoperative site-specific opioid prescription protocol and analyzed the impact on opioid prescriptions. Methods This is a retrospective cohort study. A postoperative opioid prescription protocol was implemented within our otolaryngology department at a tertiary academic medical center on January 1, 2020. Retrospective chart review was completed for all patients undergoing otolaryngology surgery from November 1, 2019, to February 29, 2020 (2 months before and after initiation of intervention; n = 1070). The primary outcome was change in the amount of opioid prescribed for the preintervention and postintervention cohorts. Unplanned contact related to pain and opioid refills were tracked to assess pain control. Results A total of 940 cases were included; adult and pediatric data were analyzed separately. There were 489 pediatric cases, 250 preintervention and 239 postintervention. There was a significant decrease in the amount of opioid prescribed per pediatric patient in the postintervention cohort (2.7 versus 0.32 morphine milligram equivalents, P = 0.02), and 99% of patients were not prescribed opioids at all. There was no significant change in unplanned contact, and no refills were required. There were 451 adult cases, 200 preintervention and 251 postintervention. There was no statistically significant decrease in the amount of opioid prescribed per adult patient (56.8 versus 51.7 morphine milligram equivalents, P = 0.23). There was no significant increase in unplanned contact or refills. Conclusions A postoperative opioid prescribing protocol can reduce the amount of opioid prescribed without increasing unplanned contact or opioid refills.

Original languageEnglish (US)
Pages (from-to)E992-E998
JournalJournal of patient safety
Issue number6
StatePublished - Sep 1 2022


  • opioid protocol
  • otolaryngology
  • pain management
  • postoperative opioid
  • postoperative pain

ASJC Scopus subject areas

  • Leadership and Management
  • Public Health, Environmental and Occupational Health


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