(A134) Optimizing Opioid Prescribing Practices Post Thyroidectomy: A Quality Improvement Intervention

Monday, October 13, 2025

12:00 PM - 1:00 PM EDT

Location: OTO EXPO, Posters

Presenting Author(s)

Mohammad Omer, BSc

Medical Student
University of Calgary
Calgary, Alberta, Canada

Co-Author(s)

FA

Francisco Aguirre, P.Eng., MBA

Senior Quality Improvement Consultant
Alberta Health Services
Calgary, Alberta, Canada
AG

Andrew Graham, MD

Foothills Medical Centre, Alberta, Canada
RH

Robertson Harrop, MD, MSc

Alberta Children's Hospital, Alberta, Canada
SC

Shamir Chandarana, MD, MSc

Head and Neck Oncology/ Reconstructive Surgery
Foothills Medical Center
Calgary, Alberta, Canada
MD

Michael Deutschmann, MD

Clinical Assistant Professor
University of Calgary
Calgary, Alberta, Canada
RH

Robert Hart, MD

Foothills Medical Centre, Alberta, Canada
Ashley V. Hinther, MD, MSc

Resident
Foothills Medical Centre
Calgary, Alberta, Canada
MH

Monica Hoy, MD

University of Calgary, United States
DL

Devon Livingstone, MD, MTM

University of Calgary, United States
WM

Wayne W. Matthews, MD

Assoc. Prof.
Ohlson Research Initiative
Calgary, Alberta, Canada
DR

Derrick R. Randall, MD, MSc

Clinical Associate Professor
University of Calgary
Calgary, Alberta, Canada

Senior Author(s)

Jonathan Yip, MD, FRCSC, MSc(HQ)

Clinical Assistant Professor
Section of Otolaryngology - Head and Neck Surgery, University of Calgary
Calgary, Alberta, Canada

Disclosure(s):

Mohammad Omer, BSc: No relevant relationships to disclose.

Michael Deutschmann, MD: No relevant relationships to disclose.

Derrick R. Randall, MD, MSc: No relevant relationships to disclose.

Jonathan Yip, MD, FRCSC, MSc(HQ): No relevant relationships to disclose.

Introduction: Overprescription of opioids for acute surgical pain have been a significant contributor to chronic opioid use, misuse, and diversion. This quality improvement (QI) intervention aimed to reduce opioid prescriptions following adult thyroidectomies amongst opioid-naive patients (ONPs).

Methods: A Thyroid Task Force established a multi-modal post-thyroidectomy pain management protocol based on literature review and expert opinion. The QI intervention was initiated on Sep. 1, 2023. A target dosage of 10 morphine milligram equivalents (MME) was chosen. The main outcome was discharge opioid prescriptions, process measure was percentage of discharge prescriptions exceeding target MME, and balancing measure was opioid prescription refills. To ascertain the patients’ opioid prescription, a unique linkage of an institutional database and provincial database was developed. Data was analyzed using control charts, and compared all measures between pre-intervention and post-intervention groups.

Results: A total of 79 total and 133 hemi-thyroidectomy ONPs were included in the pre-intervention phase, with 102 and 141 ONPs in the post-intervention phase.

Total thyroidectomy: A mean of 69.1 MME (SD 61.1 MME) was prescribed during pre-intervention, compared to 8.71 MME (SD 10.97 MME) post-intervention. Pre-intervention, 62% of patients were given prescriptions exceeding 10 MME, compared to 39% post-intervention.

Hemi-thyroidectomy: A mean of 67.5 MME (SD 68.3 MME) was prescribed during pre-intervention, compared to 12.5 MME (SD 21.8 MME) post-intervention. Pre-intervention, 54% of patients were given prescriptions exceeding 10 MME compared to 24% post-intervention.

No difference in balancing measures were noted pre- vs. post-intervention.

Conclusions: A significant reduction in opioids prescribed at discharge was achieved. Future efforts will incorporate patient-reported outcomes, as well as better elucidate factors behind non-adherence to recommendations.