Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons · 2026
Personalized Opioid Prescribing With an Individualized Tapering Protocol Following Orthognathic Surgery Reduces the Amount of Unused Opioid.
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Alsabbagh Amr, Kelvey Matthew, Matheson Kara, Davis Benjamin, Kwofie M Kwesi, Doucet Jean-Charles
Аннотация
BACKGROUND: Orthognathic surgery may result in opioid prescribing that exceeds patient need, creating surplus medication.
PURPOSE: To compare unused hydromorphone after orthognathic surgery between personalized inpatient-use-based prescribing with tapering and standardized fixed-dose prescribing.
STUDY DESIGN, SETTING, AND SAMPLE: Prospective single-center randomized trial (Dalhousie University, Halifax, Nova Scotia; April 2023-April 2024). Adults undergoing single- or double-jaw orthognathic surgery were stratified and then randomized by 1:1 block randomization.
PREDICTOR VARIABLE: Postoperative analgesic protocol, being a standardized opioid prescription (SOP) or personalized opioid prescription (POP) based on inpatient opioid use with individualized tapering.
PRIMARY OUTCOME VARIABLE: Unused hydromorphone at 2 weeks, measured in milligrams. Secondary outcomes included opioid consumption, prescription amount, pain scores, satisfaction, and unanticipated opioid prescriptions.
COVARIATES: Age, sex, body mass index, American Society of Anesthesiologists classification, psychiatric history, substance use, surgical plan, operative duration, anesthesia type, corticosteroid dosing, preoperative anxiety, inpatient hydromorphone use, and nonopioid analgesic use.
ANALYSES: Median unused hydromorphone was compared between groups using Mann-Whitney U tests. Categorical variables were compared using χ2 or Fisher's exact tests. Negative binomial regression evaluated the association between prescribing protocol and unused hydromorphone after baseline covariate adjustment. Statistical significance set at P < .05.
RESULTS: 201 subjects were enrolled; 151 completed the study (74 SOP; 77 POP; 25% attrition). Mean age was 31.4 years (SD, 10.9), and 95 subjects (63%) were female. Unused hydromorphone was lower with POP than SOP after single-jaw surgery with a median of 4.0 mg (interquartile range [IQR], 3.0 to 6.0) versus 36.5 mg (IQR, 15.0 to 40.0; P < .001), and after double-jaw surgery at 4.0 mg (IQR, 3.5 to 4.8) versus 29.0 mg (IQR, 18.5 to 40.0; P < .001). Following multivariable adjustment, hydromorphone surplus was associated with POP assignment (incidence rate ratio, 0.19; 95% CI, 0.14 to 0.26; P < .001) and female sex (incidence rate ratio, 0.71; 95% CI, 0.53 to 0.94; P = .02). Postoperative hydromorphone consumption was lower across all surgeries with POP at 1.0 mg (IQR, 0.0 to 6.0) versus 7.0 mg (IQR, 0.0 to 24.5; P = .01). Pain scores were similar between groups (P = .7). Satisfaction was similar in the single-jaw cohort between SOP and POP and was higher in POP after double-jaw surgery: 22.0 (IQR, 19.0 to 24.0) versus 19.5 (IQR, 15.0 to 21.0; P = .004).
CONCLUSION: Personalized opioid prescribing after orthognathic surgery reduced absolute postoperative opioid surplus without compromising pain control or satisfaction.
PURPOSE: To compare unused hydromorphone after orthognathic surgery between personalized inpatient-use-based prescribing with tapering and standardized fixed-dose prescribing.
STUDY DESIGN, SETTING, AND SAMPLE: Prospective single-center randomized trial (Dalhousie University, Halifax, Nova Scotia; April 2023-April 2024). Adults undergoing single- or double-jaw orthognathic surgery were stratified and then randomized by 1:1 block randomization.
PREDICTOR VARIABLE: Postoperative analgesic protocol, being a standardized opioid prescription (SOP) or personalized opioid prescription (POP) based on inpatient opioid use with individualized tapering.
PRIMARY OUTCOME VARIABLE: Unused hydromorphone at 2 weeks, measured in milligrams. Secondary outcomes included opioid consumption, prescription amount, pain scores, satisfaction, and unanticipated opioid prescriptions.
COVARIATES: Age, sex, body mass index, American Society of Anesthesiologists classification, psychiatric history, substance use, surgical plan, operative duration, anesthesia type, corticosteroid dosing, preoperative anxiety, inpatient hydromorphone use, and nonopioid analgesic use.
ANALYSES: Median unused hydromorphone was compared between groups using Mann-Whitney U tests. Categorical variables were compared using χ2 or Fisher's exact tests. Negative binomial regression evaluated the association between prescribing protocol and unused hydromorphone after baseline covariate adjustment. Statistical significance set at P < .05.
RESULTS: 201 subjects were enrolled; 151 completed the study (74 SOP; 77 POP; 25% attrition). Mean age was 31.4 years (SD, 10.9), and 95 subjects (63%) were female. Unused hydromorphone was lower with POP than SOP after single-jaw surgery with a median of 4.0 mg (interquartile range [IQR], 3.0 to 6.0) versus 36.5 mg (IQR, 15.0 to 40.0; P < .001), and after double-jaw surgery at 4.0 mg (IQR, 3.5 to 4.8) versus 29.0 mg (IQR, 18.5 to 40.0; P < .001). Following multivariable adjustment, hydromorphone surplus was associated with POP assignment (incidence rate ratio, 0.19; 95% CI, 0.14 to 0.26; P < .001) and female sex (incidence rate ratio, 0.71; 95% CI, 0.53 to 0.94; P = .02). Postoperative hydromorphone consumption was lower across all surgeries with POP at 1.0 mg (IQR, 0.0 to 6.0) versus 7.0 mg (IQR, 0.0 to 24.5; P = .01). Pain scores were similar between groups (P = .7). Satisfaction was similar in the single-jaw cohort between SOP and POP and was higher in POP after double-jaw surgery: 22.0 (IQR, 19.0 to 24.0) versus 19.5 (IQR, 15.0 to 21.0; P = .004).
CONCLUSION: Personalized opioid prescribing after orthognathic surgery reduced absolute postoperative opioid surplus without compromising pain control or satisfaction.