{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T21:53:42Z","timestamp":1789077222412,"version":"build-2803163510"},"reference-count":45,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,11,14]],"date-time":"2025-11-14T00:00:00Z","timestamp":1763078400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Procedure-specific postoperative pain in otolaryngology varies substantially, yet real-world associations between time-sensitive analgesic processes and patient-centered outcomes remain incompletely characterized in Chinese practice settings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This single-center prospective observational cohort (17 January 2021\u201331 March 2025) enrolled consecutive adults undergoing tonsillectomy, septoplasty, functional endoscopic sinus surgery (FESS), tympanoplasty\/mastoidectomy, or microlaryngoscopy at a tertiary academic hospital in Guangzhou, China. Electronic health and anesthesia records captured 48-h worst pain [numeric rating scale (NRS) 0\u201310] and a composite process quality indicator [scheduled non-opioid \u22646\u202fh plus timely post-anesthesia care unit (PACU) rescue \u226430\u202fmin for severe pain (NRS\u202f\u2265\u202f7)]. Procedure category was the primary exposure. Worst pain was analyzed using ordinary least squares regression with restricted cubic splines and provider fixed effects; the process composite using logistic regression with heteroskedasticity-consistent standard errors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 1,632 patients (mean age 38.5\u202fyears; 55.2% male), severe PACU pain occurred in 31.4%, rescue opioids in 42.5%, and timely rescue in 81.5% of those rescued (34.7% overall). Patients receiving scheduled non-opioids at discharge (80.3%) had lower 48-h pain (median 4.0 vs. 4.6), reduced opioid exposure (8.7 vs. 11.6\u202fmg oral morphine equivalent), and higher satisfaction. Procedure category dominated pain outcomes: tonsillectomy versus FESS\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u202f=\u202f1.14 [95% confidence interval (CI) 0.91\u20131.38]; microlaryngoscopy\n                      <jats:italic>\u03b2<\/jats:italic>\n                      \u202f=\u202f\u22122.02 (\u22122.34 to \u22121.70). For the process composite, higher opioid exposure predicted lower attainment (odds ratio per 5\u202fmg 0.92; 95% CI 0.90\u20130.94), non-steroidal anti-inflammatory drug use predicted higher attainment (1.25; 1.00\u20131.57).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Postoperative pain in ear, nose, and throat surgery is strongly procedure-dependent. Non-opioid-first regimens and timely rescue represent actionable quality improvement targets, requiring multicenter validation before broader implementation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2025.1682902","type":"journal-article","created":{"date-parts":[[2025,11,14]],"date-time":"2025-11-14T12:28:44Z","timestamp":1763123324000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Procedure-specific pain trajectories and process quality in elective otolaryngology surgery: a single-center cohort study"],"prefix":"10.3389","volume":"12","author":[{"given":"Dandan","family":"Wu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suqiong","family":"Ye","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuee","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuanyuan","family":"Zheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuqin","family":"Qian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nan","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,11,14]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"300","DOI":"10.3109\/15360288.2015.1065940","article-title":"Why 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ibuprofen\/acetaminophen on postoperative pain in symptomatic patients with a pulpal diagnosis of necrosis","volume":"37","author":"Wells","year":"2011","journal-title":"J Endodont"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"3","DOI":"10.4103\/joacp.joacp_164_22","article-title":"Dexamethasone in anesthesia practice: a narrative review","volume":"40","author":"Bansal","year":"2024","journal-title":"J Anaesthesiol Clin Pharmacol"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"372","DOI":"10.1016\/j.ejpain.2009.06.009","article-title":"Rhythmic pattern of PCA opioid demand in adults with cancer pain","volume":"14","author":"Schiessl","year":"2010","journal-title":"Eur J Pain"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"1127","DOI":"10.1097\/sla.0000000000003621","article-title":"The impact of complications and pain on patient satisfaction","volume":"273","author":"Berkowitz","year":"2021","journal-title":"Ann 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