How Much Opioid Medication Do Patients Need After Orthognathic Surgery?

PURPOSE:Opioid misuse is a public health crisis. It is incumbent upon surgeons to understand analgesic requirements for operations they perform to inform responsible prescribing practices. The purpose of this study was to quantify opioid use following orthognathic surgery. METHODS:This is a prospective cohort study including consecutive patients that had orthognathic surgery at the Boston Children's Hospital from May 2020 to September 2021. To be included, subjects had to have had a Le Fort I osteotomy, bilateral sagittal split osteotomies, or both. Subjects were excluded if they had a craniofacial syndrome (not including cleft lip and palate) or did not complete the study. Postoperative prescriptions and instructions were standardized. The primary outcome variable was total postoperative opioid use (inpatient + outpatient). Inpatient opioid delivery was recorded from the electronic medical record. Outpatient opioid use was ascertained via electronic questionnaire each day for 7 postoperative days. Descriptive and analytic statistics were calculated. RESULTS:Thirty-five subjects (54% male, age 18.7 ± 2.7 years) were included. Thirty-two subjects (91%) used postoperative opioid analgesia as inpatients, outpatient, or both, with mean total use of 18.2 ± 20.9 morphine milligram equivalents/subject (equivalent to 7.3 ± 8.4 oral oxycodone 5-mg doses). Nine (26%) subjects received inpatient opioid but did not use any oral opioid after discharge. As outpatients, a mean of 3.9 ± 5.5 oral oxycodone 5-mg dose was used per patient over 2.1 ± 2.1 postoperative days. Le Fort I osteotomy-only procedures had significantly lower (P = .032) and combined Le Fort I osteotomy and bilateral sagittal split osteotomy operations had significantly higher (P = .003) opioid requirements than the mean. Length of procedure and hospital length of stay were significant predictors of analgesic need, with an increase of 0.34 oxycodone doses/subject for each 10-minute increase in procedure time and 0.20 oxycodone doses/subject for each 1-hour increase in length of stay. Pain level on the first postoperative day was also a predictor of total opioid use (P < .050). CONCLUSION:Opioid use after orthognathic surgery is less than expected. Caution is necessary to avoid overprescribing.