Associations Between Physician Prescribing Behavior and Persistent Postoperative Opioid Use Among Cancer Patients Undergoing Curative-intent Surgery: A Population-based Cohort Study.

OBJECTIVE: This study aimed to evaluate the association between prescribers' opioid prescribing history and persistent postoperative opioid use in cancer patients undergoing curative-intent surgery. BACKGROUND: Study has shown that patients may be over-prescribed analgesics after surgery. However, whether and how the prescriber's opioid prescribing behavior impacts persistent opioid use is unclear. METHODS: All adults with a diagnosis of solid cancers who underwent surgery during the study period (2009-2015) in Alberta, Canada and were opioid-naïve were included. The key exposure was the historical opioid-prescribing pattern of a patient's most responsible prescriber. The primary outcome was "new persistent postoperative opioid user," was defined as a patient who was opioid-naïve before surgery and subsequently filled at least 1 opioid prescription between 60 and 180 days after surgery. RESULTS: We identified 24,500 patients. Of these, 2106 (8.6%) patients became a new persistent opioid user after surgery. Multivariate analysis demonstrated that patients with most responsible prescribers that historically prescribed higher daily doses of opioids (≥50 vs <50 mg oral morphine equivalent) had an increased risk of new persistent opioid use after surgery (odds ratio = 2.41, P < 0.0001). In addition to the provider's prescribing pattern, other factors including younger age, comorbidities, presurgical opioid use, chemotherapy, type of tumor/surgical procedure were also found to be independently associated with new persistent postoperative opioid use. CONCLUSIONS: Our results suggest that prescriber with a history of prescribing a higher opioid dose is an important predictor of persistent postoperative opioid use among cancer patients undergoing curative-intent surgery.

An Evaluation of On-Call Otolaryngology Consultations: Assessing an Increasing Workload.

OBJECTIVE: This study compares the volume of on-call otolaryngology consultations in a tertiary care center over a 5-year period. The objective of this study was to identify changes in the volume of consultations in an inpatient setting. METHODS: A cross-sectional retrospective study was performed to determine the volume of consultations. The years 2010 and 2015 were the timepoints for the cross-sectional analysis. A review of electronic medical records was performed to identify all patients associated with the otolaryngology service from the emergency department, inpatient wards, and intensive care units. The primary outcome was the number of otolaryngology consultations per year. RESULTS: The number of on-call consultations in 2010 was 992. In 2015, the number of on-call consultations was 2174. This represents a 120% increase in the number of consultations over a 5-year period ( P < .001). CONCLUSION: There has been a significant increase in the volume of on-call otolaryngology consultations at our tertiary care center. This increase has the potential to adversely affect patient care. A better understanding of the cause of this increase may allow policymakers and health care practitioners to improve patient access, physician workloads, and resource allocation.