Consumption of Pro Re Nata Inpatient Opioids Following Surgical Treatment of Severe Odontogenic Infections

Abstract

<h3>Purpose</h3> The purpose of this study was to analyze the pro re nata (PRN) opioid consumption of patients with severe odontogenic infections following operating room incision and drainage using odontogenic infection severity scores. The null hypothesis was that no statistically significant difference in post-operative inpatient PRN opioid consumption exists between patients with infections of higher severity score and lower severity score. <h3>Methods</h3> This retrospective study reviewed consecutive charts of all patients admitted for severe odontogenic infections to the UTSW and Parkland Memorial hospital from January 2016 to December 2020. All patients admitted for greater than one hospital day and treated with surgical incision and drainage in the operating room with an American Society of Anesthesiologists (ASA) physical classification score of 1 or 2 as ranked by the anesthesia team prior to surgery were included. Patients with chronic pain conditions, history of substance abuse, or infections of non-odontogenic origin were excluded. Patients that required advanced airway post-surgery and intensive care unit stay or multiple operations were also excluded. Post-operative opioid doses were tabulated from the time the patient arrived on the floor as inpatient post-surgery until discharge using equianalgesic opioid tables and published conversion factors (1,2). Severity scores were assigned based on the risk to the airway and vital structures as described by Flynn et al (3). Patients with a severity score greater than or equal to five were designated as group A and less than five group B. The primary predictor variable was severity score, and the primary outcome variable was the amount of milligram morphine equivalents (MME) administered. Comparisons between Group A and Group B were conducted for age, ASA classification, hospital duration, severity score, and MME using t-tests. Values of p < 0.05 were considered statistically significant. <h3>Results</h3> A total of 93 subjects met the inclusion criteria. Group A included 40 subjects and group B included 53 subjects. The average age of subjects in group A was 38.28 years (SD=10.92), and in group B 38.03 years (SD=12.53). There was no significant difference between the groups in age (p = 0.93). The average hospital duration for patients in group A was 3.85 days (SD=1.17). Group B had an average hospital duration of 3.72 days (SD=1.08). There was no significant difference between the groups in hospital duration (p = 0.57). Group A consumed an average MME of 39.85, while group B consumed an average of 23.43. Group A consumed a significantly greater amount of PRN post-operative inpatient opioid medications (p = 0.02). <h3>Conclusion</h3> Patients with higher odontogenic infection severity scores consumed more post-operative PRN opioid analgesic medications. Given that odontogenic infections are largely preventable, it is imperative to prevent the progression of odontogenic infections to limit patient exposure to opioid medication.