{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,9]],"date-time":"2026-05-09T11:32:34Z","timestamp":1778326354323,"version":"3.51.4"},"reference-count":28,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2022,8,30]],"date-time":"2022-08-30T00:00:00Z","timestamp":1661817600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000058","name":"Substance Abuse and Mental Health Services Administration","doi-asserted-by":"publisher","award":["1H79TI083288"],"award-info":[{"award-number":["1H79TI083288"]}],"id":[{"id":"10.13039\/100000058","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["aao-hnsfjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Otolaryngol.--head neck surg."],"published-print":{"date-parts":[[2023,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To evaluate the impact of a quality improvement bundle on opioid discharge prescribing following thyroidectomy and parathyroidectomy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This before\u2010and\u2010after study included patients undergoing thyroidectomy or parathyroidectomy at an academic medical center. The quality improvement bundle included a patient education flyer, electronic health record order sets with multimodal analgesia regimens, and provider education. The preimplementation cohort included patients treated from January 2018 to December 2019. The postimplementation cohort included patients treated from June 2021 to August 2021. The primary outcome was the proportion of patients who received new opioid discharge prescriptions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 160 patients were included in the preimplementation cohort, and the first 80 patients treated after bundle implementation were included in the postimplementation cohort. Patients receiving new opioid discharge prescriptions decreased from 80% (128\/160) in the preimplementation cohort to 35% (28\/80) in the postimplementation cohort with an unadjusted absolute reduction of 45% (95% CI, 33%\u201057%; <jats:italic>P<\/jats:italic> &lt; .001; number needed to treat = 3) and an adjusted odds ratio (OR) of 0.08 (95% CI, 0.04\u20100.19; <jats:italic>P<\/jats:italic> &lt; .001). The bundle was associated with reductions in opioid discharge prescriptions that exceeded 112.5 oral morphine milligram equivalents (33% pre\u2010 vs 10% postimplementation; adjusted OR, 0.20; <jats:italic>P<\/jats:italic> = .001) or 5 days of therapy (17% pre\u2010 vs 6% postimplementation; adjusted OR, 0.34; <jats:italic>P<\/jats:italic> = .049).<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>Implementation of a pain management quality improvement bundle reduced opioid discharge prescribing following thyroidectomy and parathyroidectomy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Implications for Practice<\/jats:title><jats:p>Unnecessary opioid prescriptions generate unused opioids in patients\u2019 homes that can lead to opioid misuse. We believe that this bundle reduced the risk for opioid misuse in our community.<\/jats:p><\/jats:sec><jats:sec><jats:title>Registration<\/jats:title><jats:p>The study was registered at ClinicalTrials.gov (NCT04955444) before implementation.<\/jats:p><\/jats:sec>","DOI":"10.1177\/01945998221121626","type":"journal-article","created":{"date-parts":[[2022,8,30]],"date-time":"2022-08-30T12:01:30Z","timestamp":1661860890000},"page":"176-184","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Optimization of Opioid Discharge Prescriptions Following Thyroid and Parathyroid Surgery"],"prefix":"10.1002","volume":"169","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1390-1409","authenticated-orcid":false,"given":"Elsie","family":"Rizk","sequence":"first","affiliation":[{"name":"Department of Pharmacy Houston Methodist  Houston Texas USA"},{"name":"Department of Surgery Houston Methodist Hospital  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fangzheng","family":"Yuan","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Houston Methodist  Houston Texas USA"},{"name":"Department of Surgery Houston Methodist Hospital  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Feibi","family":"Zheng","sequence":"additional","affiliation":[{"name":"Department of Surgery Houston Methodist Hospital  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ezekiel","family":"Fink","sequence":"additional","affiliation":[{"name":"Department of Neurology Houston Methodist Hospital  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Navjot","family":"Kaur","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Houston Methodist  Houston Texas USA"},{"name":"Department of Surgery Houston Methodist Hospital  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anh Thu","family":"Tran","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Houston Methodist  Houston Texas USA"},{"name":"Department of Surgery Houston Methodist Hospital  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tomona","family":"Iso","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Houston Methodist  Houston Texas USA"},{"name":"Department of Surgery Houston Methodist Hospital  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nadia G.","family":"Mohyuddin","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Houston Methodist Hospital  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Apurva A.","family":"Thekdi","sequence":"additional","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery Houston Methodist Hospital  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gilchrist L.","family":"Jackson","sequence":"additional","affiliation":[{"name":"Department of Surgery Houston Methodist Hospital  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew A.","family":"Wanat","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Houston Methodist  Houston Texas USA"},{"name":"Prescription Drug Misuse Education and Research Center, College of Pharmacy University of Houston  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J. Douglas","family":"Thornton","sequence":"additional","affiliation":[{"name":"Prescription Drug Misuse Education and Research Center, College of Pharmacy University of Houston  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joshua T.","family":"Swan","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Houston Methodist  Houston Texas USA"},{"name":"Department of Surgery Houston Methodist Hospital  Houston Texas USA"},{"name":"Center for Outcomes Research Houston Methodist  Houston Texas USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2022,8,30]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1526-4637.2006.00255.x"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(19)30428-3"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0000000000001034"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/ajhp\/zxy042"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000003443"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoto.2018.0987"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoto.2018.2427"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2018.07.659"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000003777"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jss.2019.07.039"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1177\/0194599818797574"},{"key":"e_1_2_9_13_1","unstructured":"RizkE.Opioid use after thyroid and parathyroid surgeries.ClinicalTrials.gov identifier: NCT04955444. Published2021. Accessed April 12 2022.https:\/\/clinicaltrials.gov\/ct2\/show\/NCT04955444"},{"issue":"2","key":"e_1_2_9_14_1","article-title":"Clinical practice guideline: opioid prescribing for analgesia after common otolaryngology operations","volume":"164","author":"Anne S","year":"2021","journal-title":"Otolaryngol Head Neck Surg"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2008.08.010"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-0258(19980730)17:14<1623::AID-SIM871>3.0.CO;2-S"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1177\/0163278703255230"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2020.08.004"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jss.2020.03.010"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.21037\/jtd-20-431"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2019.06.056"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2018.2083"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-155-5-201109060-00354"},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000002094"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2017.10.012"},{"key":"e_1_2_9_26_1","author":"Texas House Bill 2174: the 10\u2010day opioid prescribing limit for acute pain","journal-title":"Health and Safety Code. 2019: \u00a7481.07636"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(19)30854-2"},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bpa.2014.03.005"},{"key":"e_1_2_9_29_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000002497"}],"container-title":["Otolaryngology\u2013Head and Neck Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1177\/01945998221121626","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1177\/01945998221121626","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/aao-hnsfjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1177\/01945998221121626","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T14:49:03Z","timestamp":1760971743000},"score":1,"resource":{"primary":{"URL":"https:\/\/aao-hnsfjournals.onlinelibrary.wiley.com\/doi\/10.1177\/01945998221121626"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,8,30]]},"references-count":28,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2023,7]]}},"alternative-id":["10.1177\/01945998221121626"],"URL":"https:\/\/doi.org\/10.1177\/01945998221121626","archive":["Portico"],"relation":{},"ISSN":["0194-5998","1097-6817"],"issn-type":[{"value":"0194-5998","type":"print"},{"value":"1097-6817","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,8,30]]},"assertion":[{"value":"2022-06-20","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-08-08","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-08-30","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}