(A567) Inpatient Opioid Use in Head and Neck Microvascular Free Flap Reconstruction

Monday, October 13, 2025

12:00 PM - 1:00 PM EDT

Location: OTO EXPO, Posters

Presenting Author(s)

Patricia Timothee, MD

Resident
Georgetown University Hospital
Washington, DC, United States

Co-Author(s)

AB

Alessandra Bliss, MD

Georgetown University Hospital, United States
DB

Daniel L. Blumenthal, MD

Fellow
Childrens National Medical Center
Washington, District of Columbia, United States
JD

John Dowd, Other

Georgetown University, United States
BD

Bruce J. Davidson, MD

Medstar Georgetown University Hospital, Department of Otolaryngology/Head & Neck Surgery, United States
Michael J. Reilly, MD

Attending Physician
Georgetown University Hospital
Washington, DC, United States
MP

Matthew L. Pierce, MD

Director, Head and Neck Oncology
Georgetown University Hospital
Washington, District of Columbia, United States

Senior Author(s)

JG

Jonathan P. Giurintano, MD, MS

Associate Professor
MedStar Georgetown University Hospital
Washington, District of Columbia, United States

Disclosure(s):

Patricia Timothee, MD: No relevant relationships to disclose.

Daniel L. Blumenthal, MD: No relevant relationships to disclose.

Matthew L. Pierce, MD: No relevant relationships to disclose.

Jonathan P. Giurintano, MD, MS: No relevant relationships to disclose.

Introduction: The primary objective is to determine if patients undergoing osseous microvascular free flap reconstruction (MFFR) of head and neck defects have higher inpatient pain requirements compared to those undergoing non-osseous MFFR. Secondary objectives include evaluating the impact of a multimodal analgesia (MMA) protocol inpatient opioid usage, and evaluating the impact of COVID-19 visitor restrictions on inpatient opioid administration.

Methods: A retrospective chart review was performed for all patients who underwent MFFR by the Otolaryngology – Head and Neck Surgery service at MedStar Georgetown University Hospital and MedStar Washington Hospital Center from January 1, 2018, to June 30, 2024. The primary outcome was total morphine equivalent doses (T-MED) and MED per day (MED-PD) in osseous and non-osseous free flap (FF) patients. Doses of all narcotic medications were recorded. MED was calculated using conversion factors for each drug.

Results: A total of 318 patients (mean[SD] age, 64 [12.3] years; 207[65%] male) met inclusion criteria and were included in the study. The T-MED in the osseous FF cohort was 224.48 and 173.88 in the non-osseous FF cohort (p=0.127295). The MED-PD of hospitalization was 16.38 in the osseous FF cohort and 17.53 in the non-osseous cohort (p = 0.671399). Prior to implementation of an MMA protocol, MED-PD averaged 25.9; however, after initiation of an MMA protocol, MED-PD averaged 11.24 (p < 0.0001). During the period of COVID-19 inpatient visitor restrictions, average T-MED was 234.57 compared to 181.32 (p=0.163232), and MED-PD was 20.64 compared to 16.9 during normal inpatient visitor rules (p = 0.251387).

Conclusions: The findings suggest that there is no significant difference in post-operative inpatient opioid pain requirement for patients undergoing osseous MFFR compared to non-osseous MFFR. The implementation of an MMA protocol at our institution was associated with significantly decreased inpatient narcotic use, while there was no significant difference in inpatient opioid use observed during the strict visitor restrictions instituted during the COVID-19 pandemic.