Perioperative Opioid Use and Risk of Persistent Use After Common Otolaryngologic Procedures

OBJECTIVE: The objective of this study was to evaluate the incidence of perioperative opioid prescription and the development of new persistent opioid usage in patients prescribed perioperative opioids for common otolaryngological procedures. STUDY DESIGN: Retrospective cohort study. SETTING: TriNetX US Collaborative Research Network. METHODS: The TriNetX US Collaborative Research Network was queried to create cohorts of opioid-naive adult patients who underwent tonsillectomy, sinus surgery, parotidectomy, septoplasty, tympanoplasty, rhinoplasty, or parathyroidectomy between 2010 and 2024. Patients prescribed perioperative opioids (2 weeks before to 1 month after surgery) were compared with those not prescribed opioids. Persistent opioid use was defined as opioid prescription between 3 and 9 months after surgery. Propensity score matching was performed based on demographics, smoking status, mental health diagnoses (eg, mood, anxiety, personality, and substance use disorders), preoperative pain conditions (eg, back, neck, and joint pain), as well as other medical comorbidities, and healthcare utilization. RESULTS: We identified 319,395 opioid-naive patients who underwent the selected otolaryngological procedures. Of these patients, 273,898 (85.8%) received perioperative opioids. The rate of perioperative opioid usage was highest for parotidectomy. Across all procedures, patients who received perioperative opioids were more likely to develop new persistent opioid use. The highest risk ratios (RR) were observed for parotidectomy (RR: 2.64; 95% CI: 1.94, 3.59) and tympanoplasty (RR: 2.01; 95% CI: 1.53, 2.66). CONCLUSIONS: Perioperative opioid prescription following common otolaryngological procedures is associated with a higher risk of new persistent opioid use. These findings highlight the need for careful opioid prescribing to reduce long-term opioid dependence.