Changes in Opioid Prescribing Habits for Patients Undergoing Rhinoplasty and Septoplasty

Aulet RM, Trieu V, Landrigan GP, Millay DJ.

PubMed 31600382 Publisher (DOI)Free full text (PMC)

What this paper says

After Vermont opioid legislation took effect in July 2017, opioid tablets prescribed after nasal surgery fell from 17.5 to 9.7 per patient with no increase in pain complaints, calls, or second prescriptions.

Overview

Legislative change is one route to reducing opioid prescribing. This single-institution case-control study compared prescribing for nasal surgery patients before and after new Vermont laws, and checked whether the reduction left patients in pain.

Sections of note

80 patients undergoing rhinoplasty and septoplasty, with or without turbinate reduction, at the University of Vermont between March 2016 and May 2018.
Excluded: those having concurrent endoscopic sinus surgery, and those under 14 years.
Patients were divided by surgery date before or after the legislative change on July 1, 2017.
Mean age 41.4 years in the before group, 15 women (37.5%), and 40.6 years in the after group, 16 women (40.0%).
Pills prescribed fell significantly from 17.5 to 9.7, P below .001.
Morphine milligram equivalents prescribed fell from 130.9 to 73.2, P below .001.
The Vermont Prescription Monitoring System was queried for prescriptions filled within 30 days.
No statistical difference in postoperative telephone calls for pain, second prescriptions, or pain complaints at the follow-up visit. Level of evidence 3.

What it means for a patient

Prescribed opioid quantity was roughly halved without patients reporting more pain or needing more medication.
Checking the state registry captures prescriptions filled anywhere, not just those written by the surgeon.
This suggests the earlier higher amounts exceeded what patients needed.
Limits: 80 patients at one institution, groups defined by date rather than randomized, and pain assessed by calls and visit complaints rather than a validated scale.

Why this paper matters

It provides direct evidence that a substantial prescribing reduction did not leave patients undertreated, which is the usual objection to such policies. Registry linkage strengthens the prescribing data. The small sample and the reliance on complaints rather than pain scores limit how firmly the safety claim can be stated.

Terms

Morphine milligram equivalent: A standard unit allowing different opioids to be compared by strength.
Prescription monitoring system: A state database recording controlled substance prescriptions dispensed.
Septoplasty: Straightening of the central wall inside the nose.
Turbinate reduction: Shrinking the tissue shelves on the inner nasal wall.
Case-control study: A design comparing groups defined by a characteristic, here surgery date.

Summary written by rhinoplasty.cc from the abstract, 2026-09-09; not medical advice. The authors' own abstract follows.

Abstract

Importance: Opioid prescriptions have increased substantially over the last 2 decades, contributing to the opioid epidemic. Physician practices and legislative changes play a key role in decreasing prescription opioid use.

Objective: To evaluate changes in opioid prescribing habits for patients undergoing rhinoplasty and/or septoplasty before and after the adoption of new opioid legislation.

Design, Setting, And Participants: This single-institution case-control study examined opioid prescribing habits for 80 patients who were undergoing rhinoplasty and septoplasty with or without turbinate reduction at the University of Vermont between March 2016 and May 2018. Patients were excluded if they underwent concomitant endoscopic sinus surgery or were younger than 14 years. Patients were divided by surgery date before or after legislative changes on July 1, 2017.

Exposures: Rhinoplasty and septoplasty with or without turbinate reduction.

Main Outcomes And Measures: Patient demographics and opioid prescriptions were recorded. Patients were evaluated if they reported pain during follow-up, called the office, or received a second prescription. The Vermont Prescription Monitoring System was queried to determine if opioid prescriptions were filled within 30 days of the procedure. The 2 groups were compared to test the hypothesis that opioid prescriptions had decreased after legislative changes.

Results: Of a total of 80 participants, the mean (SD) age in the before (15 women [37.5%]) and after (16 women [40.0%]) groups were 41.4 years and 40.6 years, respectively. There was a statistically significant decrease in the number of pills prescribed to the after group (17.5 to 9.7; P < .001) as well as a decrease in the morphine milligram equivalents that were prescribed (130.9 to 73.2; P < .001). There was no statistical difference in the number of postoperative telephone calls for pain, second prescriptions, or increased complaints of pain at the postoperative visit.

Conclusions And Relevance: Recent laws in Vermont regarding opioid prescribing were implemented in 2017 to curb the ongoing opioid epidemic. Our observations of patients undergoing septoplasties and rhinoplasties found a significant reduction in opioid prescriptions. This was not associated with an increase in patient complaints about postoperative pain or the need for a second prescription after surgery. This shows that we may safely be able to decrease the number of narcotic medications that we prescribe.

Level Of Evidence: 3.

Abstract as indexed by PubMed; the article is open access (PubMed Central).