Postoperative Naloxone in Otolaryngologic Surgery May Decrease Incident Overdose, Death

Introduction: Postoperative opioid prescription misuse is a substantial contributor to the US opioid epidemic, and postoperative naloxone prescription is contentious in practice guidelines. This database study analyzes associations of postoperative naloxone prescription on substance use, overdose, and death across otolaryngologic surgeries.

Methods: This is a retrospective cohort database study with propensity-score matching (PSM) conducted between July 2022 and January 2023 using TriNetX, a multinational electronic health records research network. We included adult patients who underwent tonsillectomy, parathyroid/thyroidectomy, rhinoseptoplasty, otologic, sinus, anterior and lateral skull base, and head and neck cancer (H&N) surgeries. We hypothesized that proportions of patients with substance use disorder (SUD) are identical between subspecialties and that patients who were prescribed naloxone postoperatively (cohort A) have decreased odds for experiencing SUD (ICD10 F10-19), overdose (CPT T50.901), and/or death (R99) within six months of surgery. We used odds ratios with 95% confidence intervals (OR, 95%CI) and chi-square tests. P< 0.05 was considered significant.

Results: There were 1,107,375 patients in this study. The average age was 39.7 years old, with 52% female patients. There is a significant difference in the proportion of patients with SUD undergoing different surgeries (p < 0.0001). The prevalence of SUD in the patients ranged from 4-8%, with sinus surgery reporting the lowest value and rhinoseptoplasty reporting the highest.
After 1:1 PSM for age and sex, the risk of developing new SUD in cohort A (n = 7,556) and controls undergoing parathyroid/thyroidectomy was 0.48% vs 0.87% (0.53, 0.38-0.75). The risk of death in cohort A and controls undergoing H&N surgery was 2.9% vs 4.2% (0.69, 0.62, 0.78).

Conclusions: These results suggest a protective benefit of postoperative naloxone prescription and may have important clinical implications for postoperative prescribing patterns in otolaryngologic surgery to decrease morbidity and mortality.