Otolaryngology - Head & Neck Surgery Supplement - 2020 Official Program Abstracts - P49

Oral Presentations

Objectives: Excessive postoperative opioid prescriptions
have contributed to the current epidemic. There are few studies in otolaryngology that examine procedure-specific postoperative opioid use. We aim to (1) describe our institution's
opioid-prescribing practices for several outpatient procedures
and (2) determine patient, procedure, and perioperative factors that correlate with prescribed opioids.
Methods: This was a retrospective cohort study at an academic medical center. Records from 2016 to 2019 for
480 patients who had had hemithyroidectomy, thyroidectomy, pa-rathyroidectomy, parotidectomy, selective neck dissection (SLND), or sentinel lymph node biopsy (SLNB) were
reviewed. Data were collected on demographics, length of
stay, in-hospital opioid and nonopioid pain medication use,
and opioids prescribed at discharge. Multivariable logistic
regression was run.
Results: Mean age was 59 years (SD 16.3); 53% women;
procedure breakdown: 18% hemithyroidectomy, 18% thyroidectomy, 10% parathyroidectomy, 22% parotidectomy, 13%
SLND, and 19% SLNB. In hospital, mean daily intravenous
milligram morphine equivalent (MME) was 4.3 (SD 9.2) and
oral MME was 12.5 (SD 19.7). Mean number of opioid pills
prescribed was 20.3 (SD 28.8, range, 0-300 pills). Mean MME
prescribed was 122.0 (SD 73.4). Differences in MME prescribed between procedure types were not significant. In the
multivariate logistical regression, significant predictors of
MME prescribed were age (odds ratio [OR] 0.97, P = .032),
SLNB (OR 0.25, P = .019), year (compared with 2016, OR
0.26 [P = .043] for 2017, OR 0.12 [P = .001] for 2018, and OR
0.064 [P < .001] for 2019).
Conclusions: Significant predictors of increased prescribed
MME were younger age, SLNB procedure, and more recent
year. Mean opioid prescriptions fell significantly from years
2016 to 2020.
Deep Neck Space Abscesses in a Hispanic
Population: Irrisept Irrigation System, Can It
Be Used in the Head and Neck?
Soraya AbdulHadi Martinez, MD (Presenter); Francis D.
Beauchamp-Perez; Jeamarie Pascual Marrero, MD
Objectives: Deep neck abscesses arise because of severe
complications of a head and neck infection. The most
common etiologies are odontogenic infections due to poor
oral hygiene followed by contiguous extension of tonsillar/
pharyngeal infections. Standard treatment consists of intravenous antibiotics and possible surgical intervention. We investigated the efficacy and safety of chlorhexidine gluconate
solution when used in deep neck infections.

Methods: A retrospective cross-sectional study was conducted by medical record evaluation of all patients who underwent intervention for retropharyngeal and/or parapharyngeal
neck abscesses by the otolaryngology-head and neck surgery
service of the University of Puerto Rico from 2016 to 2017. A
total of 44 patients, pediatric and adults, were evaluated after
incision and drainage were performed as part of the surgical
treatment. Outcomes and hospital course were evaluated and
compared between patients who were treated with Irrisept
(0.05% chlorhexidine gluconate) solutions after abscess drainage as opposed to other solutions.
Results: Irrisept solution showed comparable efficacy in
deep neck abscess wound-cleansing treatment as compared
with iodine, normal saline solution, or antibiotic solutions.
Conclusions: This is the first study in which Irrisept has been
evaluated in the head and neck region. We conclude that the
chlorhexidine gluconate solution is an effective and safe product that may be used as an alternative for deep neck infection
cleansing after debridement.
Developing International Consensus on the
Use of Unilateral Cochlear Implants for
Adults
Craig A. Buchman, MD (Presenter); Brian A. Kaplan, MD
Objectives: Using a modified Delphi consensus process, our
group developed a series of consensus statements regarding
the use of unilateral cochlear implants (CIs) in adults with
severe, profound, or moderate sloping to profound bilateral
sensorineural hearing loss (SNHL). Here, we present the process used and the final consensus statements.
Methods: The Delphi Consensus Group consists of 30
international CI experts. Statements were developed based on
evidence identified from a systematic literature review. The
identified publications were screened manually against prespecified eligibility criteria, and relevant data were extracted
from included studies. A modified 3-step Delphi consensus
process was used to vote on and refine the statements, consisting of 2 rounds of questionnaires and a face-to-face meeting at a final round. Consensus was defined a priori as
agreement by at least 75% of respondents. At each round, the
panel reviewed those statements that had not yet reached the
agreement threshold and marked their level of agreement
according to a 6-point Likert response scale. Panel members
were also invited to provide free-text comments on each
statement. All statements were reviewed and discussed at the
face-to-face meeting.
Results: The Delphi Consensus Group has developed 20 consensus statements on the use of unilateral CI in adults with SNHL.
These statements provide recommendations on CI awareness (1),
diagnosis (3), surgical implications (2), clinical outcomes (7),
rehabilitation (1), association of hearing loss with cognition,
depression, and social isolation (5), and cost-effectiveness (1).
Conclusions: These consensus statements represent the first
step in the development of a set of international guidelines on
best practice for CI in adults with SNHL.

Comprehensive

Current Opioid-Prescribing Practices After
Common Outpatient Otolaryngology
Procedures: Experience at Harvard
Okenwa Okose (Presenter); Tiffany Wang; Nicholas B. Abt;
Dipti Kamani, MD; Kevin S. Emerick, MD;
Gregory W. Randolph, MD

P49

Otolaryngology - Head & Neck Surgery Supplement - 2020 Official Program Abstracts

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