Predictors of opioid requirement among patients receiving free flap reconstruction to the head and neck

Zachary T Elliott; Derek S Mann; Michele Fiorella; Vanessa Christopher; Alyssa Givens; Ann Marie Martin; Tingting Zhan; Joseph Curry

doi:10.1016/j.amjoto.2023.104000

Predictors of opioid requirement among patients receiving free flap reconstruction to the head and neck

Am J Otolaryngol. 2023 Nov-Dec;44(6):104000. doi: 10.1016/j.amjoto.2023.104000. Epub 2023 Jul 11.

Authors

Zachary T Elliott¹, Derek S Mann², Michele Fiorella², Vanessa Christopher², Alyssa Givens², Ann Marie Martin², Tingting Zhan³, Joseph Curry²

Affiliations

¹ Thomas Jefferson University, Department of Otolaryngology - Head and Neck Surgery, Philadelphia, PA 191071, USA. Electronic address: elliottz14@students.ecu.edu.
² Thomas Jefferson University, Department of Otolaryngology - Head and Neck Surgery, Philadelphia, PA 191071, USA.
³ Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA 191071, USA.

PMID: 37499343
DOI: 10.1016/j.amjoto.2023.104000

Abstract

Background: Opioids are a part of standard of care treatment of acute, severe postoperative pain. However, increased opioid requirements have been shown to be associated with increased postoperative complications, morbidity, and mortality. The aim of this study was to identify potential predictive factors associated with increased or decreased opioid requirements after free tissue transfer (FTT) to the head and neck.

Materials/methods: A retrospective review was conducted on subjects who underwent head and neck reconstruction (HNR) from 2015 to 2021 at a single tertiary care center. Patients with inpatient stay over 10 days and those receiving fentanyl for sedation purposes were excluded due to EMR limitations and confounding, respectively. The total dose of opioid medication each patient received was calculated and summed using morphine milligram equivalents (MME). Statistical analysis was conducted using poisson regression and multivariable regression models.

Results: Two hundred and ninety-one patients were included. The mean opioid requirement for all subjects was 228.6 (SD 250.0) MMEs during their entire postoperative stay and the mean length of stay was 6.0 (SD 1.7) days. An established opioid prescription prior to surgical resection was the greatest predictor of increased risk for opioid requirement according univariate and multivariate analysis 2.356 (2.321-2.392), p ≤ 0.0001 and 1.833 (1.802-1.863), p ≤ 0.0001, respectively. Fibula transfers were associated with higher opioid requirements while scapula transfers were associated with decreased opioid requirements compared to other free tissue transfer types.

Conclusion: Preoperative opioid use was associated with higher postoperative opioid requirements. Multimodal pain management (MMPM) was not associated with a decreased opioid requirement; however, further studies are needed to investigate the hierarchy, dosing, and timing of MMPM in relation to opioid requirements and pain control.

Keywords: Analgesics; Head and neck surgery; Opioids; Pain management; Reconstructive surgery.

MeSH terms

Analgesics, Opioid
Free Tissue Flaps*
Humans
Opioid-Related Disorders*
Pain, Postoperative / drug therapy
Pain, Postoperative / etiology
Plastic Surgery Procedures*
Retrospective Studies

Substances

Analgesics, Opioid
1-(methacryloyloxymethyl)propyl hydrogen maleate