Otolaryngology - Head & Neck Surgery Supplement - 2020 Official Program Abstracts - P117

Oral Presentations

Narcotic Usage and Pain Control for Benign
Oropharyngeal Surgery: Are We Prescribing
Too Much?
Matthew J. Stewart (Presenter); Eric Mastrolonardo;
Adeeba Ghias; David Rosen, MD; Maurits Boon, MD;
Colin T. Huntley, MD
Objectives: There are currently no pain management guidelines for patients who receive surgery for benign pathology.
With increasing concern for opioid misuse, we sought to survey our patients on their pain control and narcotic usage in the
postoperative period following palate surgery (tonsillectomy
and adenoidectomy, uvulopalatopharyngoplasty, and expansion sphincter pharyngoplasty).
Methods: We began a prospective study in December 2019 to
survey patients who underwent palate procedures at our tertiary
care institution. Sixteen patients received a tonsillectomy and
adenoidectomy, and 2 patients received a uvulopalatopharyngoplasty. A survey was administered that evaluates postoperative
pain and narcotic usage from day of discharge to first follow-up
appointment. We used a validated visual analog scale to query
pain level on postoperative days (POD) 0, 1, 3, and 7. All narcotic prescriptions and amount used were converted to standard
units of morphine milligram equivalents (MMEs).
Results: A total of 18 patients have completed this ongoing
prospective study as of January 2020. Average MMEs prescribed were 240 MME, and the average usage was 130 MME.
Forty-six percent of prescribed narcotic medication went
unused. Pain was significant on POD 0 and POD 1 but had
mostly resolved for most patients by POD 7.
Conclusions: A significant amount of narcotic medication
went underutilized for successful pain management of palate
surgery. There is clearly a role for narcotics in the management of postoperative pain; however, patients may not need as
much as previously thought.
Outcomes for Parathyroidectomy Among
General Surgeons and Otolaryngologists: Do
Head and Neck Surgeons Make a Difference?
Ishwarya Shradha Mamidi (Presenter); Ryan Lee;
Joel W. Jones, MD
Objectives: Parathyroidectomies are most commonly performed by general surgeons and otolaryngologists. This study
aims to evaluate differences in outcomes for patients undergoing parathyroidectomy by both specialties.

Methods: The American College of Surgeons National
Surgical Quality Improvement Program (ACS NSQIP) database was queried for patients who had undergone a parathyroidectomy from 2005 to 2018. The patients were then stratified
into 2 cohorts of general surgeons and otolaryngologists and
analyzed for differences in 30-day complication rates.
Propensity score matching was then implemented in a 1:1 randomized manner to control for differences in patient demographics and preoperative comorbidities.
Results: A total of 21,848 patients who underwent surgery
were initially isolated. Procedures performed by general surgeons demonstrated significantly higher rates of superficial/
incisional surgical site infections (P = .002), unplanned intubation (P = .04), and sepsis (P = .03), in addition to shorter
operative times (mean = 85.2 min, SD 46.5 vs 95.2 min, SD
51.1; P < .001), greater length of total hospital stay (mean =
0.75 vs 0.63 days; P = .01), and longer time to discharge from
operation (mean 0.63 vs 0.53 days; P = .001). However, on
propensity score matching (n = 3421), patients undergoing
surgery by general surgeons only demonstrated higher rates of
unplanned intubation (P = .04).
Conclusions: Parathyroidectomies performed by general surgeons demonstrated higher rates of adverse events than those
performed by otolaryngologists. After propensity matching,
minimal differences were noted in complication rates between
general surgeons and otolaryngologists, indicating that though
their training may differ, their surgical approach yields similar
results.
Patient Perceptions of Resident Surgeon
Involvement in Otolaryngology
Matthew Urban, MD (Presenter); Hannah Brown;
Phillip S. LoSavio, MD
Objectives: Studies in general surgery have demonstrated
that patients may be apprehensive about resident involvement
in their surgery. This study aims to examine patients' insight
into resident surgeon participation in otolaryngology.
Methods: A 9-question survey was distributed to 200 patients
at a large, urban, tertiary care academic center from January
2018 to January 2020 at the first postoperative outpatient visit.
An informational handout was distributed to half of these
patients regarding resident roles in surgery. Subspecialty of
surgeon, complexity of case, inpatient vs outpatient surgery,
distance traveled to the hospital, race, sex, and age were
recorded.
Results: Although 97% of patients agreed that a resident is a
doctor who practices medicine under the supervision of an
attending physician, only 72% were aware that residents may
have performed portions of their surgery with close attending
supervision. Sixty-eight percent of patients wanted to know
how much of their surgery was directly performed by a resident and 6% would not want a resident involved in any part of
their surgery in the future. Responses did not vary significantly with case complexity, subspecialty, distance traveled,
race, sex, or age. Patients who had received informational
handouts were more likely to be aware that residents may
have performed portions of their surgery (P < .05). Overall,

PSQI

diagnose/treat (39%), intraoperative complications (18%),
and failure of the consent process (15%). The most frequent
injuries associated with claims were unnecessary pain (25%)
and unnecessary operation (18%).
Conclusions: Clinical negligence claims in English otolaryngology are related to several different components of patient
management and are not limited to postoperative complications. This study highlights the importance of robust pathways
in outpatient diagnostics and the consenting process, especially
in the high-risk specialty of head and neck surgery, to deliver
better patient care and reduce the impact of litigation.

P117

Otolaryngology - Head & Neck Surgery Supplement - 2020 Official Program Abstracts

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