Results
Ninety-nine patients were identified and included in the analysis. Group 1 contained 53 patients who received a routine postoperative opioid prescription and counseling against ibuprofen use. Group 2 contained 46 patients who received an ibuprofen prescription and counseling regarding the risks of opioid medications. Population level data on various characteristics for each of these groups can be found in Table 1. There was no statistically significant difference in age, ASA score, opioid use, chronic pain, or anxiety/depression between the two groups. Pathology from all cases was consistent with either inflammatory tonsillitis and/or benign tonsillar hypertrophy.
Outcomes are reported in Table 2. Fifty-one of the 53 patients (96.2%) in Group 1 filled a postoperative opioid prescription. Only 18 of the 46 patients (40.0%) in Group 2 filled a postoperative opioid prescription, which was significantly fewer than Group 1 (p<0.001). Sixteen of these 18 patients (88.9%) filled an opioid prescription on postoperative day zero or one. Six of these patients had requested opioids during their preoperative visit.
When averaged to a standard cohort of 50 patients, an ibuprofen prescription and preoperative counseling resulted in a 66.5% reduction in the amount of opioid prescribed for tonsillectomy. The average first quantity of opioid dispensed in morphine equivalents for the patients in Group 1 was 215mg ± 113mg, which is the equivalent of approximately 143mg of oxycodone. The average first quantity of opioid dispensed in morphine equivalents for the patients in Group 2 was 167mg ± 122.5mg, which is the equivalent of approximately 111mg of oxycodone, and significantly less than Group 1 (p=0.04). Based on the data in this study, 50 patients undergoing tonsillectomy without ibuprofen would collectively use 10,300mg in morphine equivalents. This translates to 6,867mg of oxycodone or 1,373 5mg tablets. On the other hand, 50 patients undergoing tonsillectomy with an ibuprofen prescription would collectively use 3,450mg in morphine equivalents. This translates to 2,300mg of oxycodone or 460 5mg tablets.
A subgroup analysis of Group 2 did not find any difference in age, race, or relevant patient factors between those who received ibuprofen and filled an opioid prescription and those who received ibuprofen and did not fill an opioid prescription. There was no statistically significant difference in bleeding rates between Groups 1 and 2 (5.3% vs 2.2%, p=0.42), though this study was not powered to detect any such difference.
A multiple logistic regression controlling for age, race, and a history of opioid use, substance abuse, chronic pain, or anxiety/depression was designed to assess the ability of an ibuprofen prescription to independently predict the likelihood of a filled postoperative opioid prescription. The only statistically significant independent predictor was an ibuprofen prescription, which significantly reduced the odds of a patient filling a postoperative opioid prescription (OR = 0.02, 95% CI 0.003, 0.09, p < 0.001).