ABSTRACT
Background: Awareness of the opioid epidemic is promoting opioid stewardship in health care. For many commonly performed procedures in general surgery and gynecology, regimented opioid prescribing practices and/or multimodal nonopioid regimens are adequate for optimizing pain management and minimizing opioid dependence. We investigated opioid prescribing patterns for otolaryngology procedures at a tertiary hospital with the aim of characterizing postoperative pain and opioid use. Methods: This cross-sectional study with a patient survey was conducted in a tertiary care academic otolaryngology practice. Patients ≥18 years who underwent 1 of 41 common surgical procedures at an academic hospital between 2013 and 2017 were enrolled. Patients with any diagnosis of malignancy were excluded. Patients were analyzed according to surgery type (rhinoplasty, sinonasal surgery, tonsillectomy, parotidectomy, thyroidectomy, otologic surgery, and laryngoscopy), and those who had surgery in 2017 were surveyed via telephone interview using a standardized questionnaire. Results: A total of 3,152 patients met the study criteria, of whom 95.7% received an opioid prescription. Commonly prescribed opioid agents were hydrocodone-acetaminophen, oxycodone-acetaminophen, and acetaminophen-codeine. A median of 30 pills was prescribed per surgery, with little variation between different surgery types. Reported patient utilization was highest for parotid surgery and tonsillectomy and lowest for laryngoscopic, thyroid, and otologic surgery. Among all patients who received a prescription for opioids, 5.8% required a refill. Among the surveyed patients, 19.6% reported that they did not obtain the prescribed opioid, while 58.4% said they took half, less than half, or none of the prescribed opioid supply. Only 10.8% of surveyed patients disposed of the excess drugs in a recommended fashion. Conclusion: Our findings showed that the quantity of opioid prescriptions does not reflect actual patient analgesic use for elective surgeries in otolaryngology. Differential analgesic requirements for specific surgeries should be considered when prescribing postoperative analgesia.
ABSTRACT
Trade-offs may influence both physiological and evolutionary responses to co-occurring stressors, but their effects on both plastic and adaptive responses to climate change are poorly understood. To test for genetic and physiological trade-offs incurred in tolerating multiple stressors, we hybridized two populations of the intertidal copepod Tigriopus californicus that were divergent for both heat and salinity tolerance. Starting in the F2 generation, we selected for increased tolerance of heat, low salinity, and high salinity in replicate lines. After five generations of selection, heat-selected lines had greater heat tolerance but lower fecundity, indicating an energetic cost to tolerance. Lines selected for increased salinity tolerance did not show evidence of adaptation to their respective environments; however, hypo-osmotic selection lines showed substantial loss of tolerance to hyperosmotic stress. Neither of the salinity selection regimes resulted in diminished heat tolerance at ambient salinity; however, simultaneous exposure to heat and hypo-osmotic stress led to decreased heat tolerance, implying a physiological trade-off in tolerance to the two stressors. When we quantified the transcriptomic response to heat and salinity stress via RNA sequencing, we observed little overlap in the stress responses, suggesting the observed synergistic effects of heat and salinity stress were driven by competing energetic demands, rather than shared stress response pathways.
