Procedural Guidelines Research Articles

O pré-natal de mulheres atendidas no serviço público e particular de saúde no interior do Tocantins: Principais características

Objective: to describe the prenatal care of women assisted in the public and private health service in a city in the interior of Tocantins - Brazil. Method: a descriptive study with a quantitative and qualitative approach. Twenty women who underwent prenatal care in up to one year participated in the research, 10 from the public service and 10 from the private service. Data collection took place in December 2019, through the application of a questionnaire. Results: several weaknesses were found, with only 30% of women seen in the public service considering the service as always adequate and 80% have the same perception of the private service. In carrying out guidelines, exams, procedures and interventions necessary during prenatal care, the public service is closer to its integrality. Conclusion: the main weaknesses are related to the reception / attachment of the pregnant woman to the health professional; guidelines for pregnant women and basic procedures recommended by the main health protocols and policies.

Applications of thick rigid flat-folding origami to practical objects

This paper presents an approach to rigid flat origami design, with applications including a portable boat and travel-size musical instrument. The conditions for rigid flat folding are summarised, and a set of procedural design guidelines are presented systematically to apply these principles, including a symmetry-based strategy for achieving additional compactness, a corner-fold insertion technique to achieve constraint in the desired shape while preserving mobility for transition to the flat configuration, and a plane-assignment algorithm for the flat configuration. The portable boat is developed from a symmetric, four-vertex origami pattern, and a simplified construction is identified through eliminating the panels which remain adjacent in the open and flat-folded configurations. The musical instrument is a modified box in the shape of an octagonal right prism, and is designed using methods similar to those used in the boat construction. Prototyping methods for both objects, and light testing, are presented.

Applications of thick rigid flat-folding origami to practical objects

This paper presents an approach to rigid flat origami design, with applications including a portable boat and travel-size musical instrument. The conditions for rigid flat folding are summarised, and a set of procedural design guidelines are presented systematically to apply these principles, including a symmetry-based strategy for achieving additional compactness, a corner-fold insertion technique to achieve constraint in the desired shape while preserving mobility for transition to the flat configuration, and a plane-assignment algorithm for the flat configuration. The portable boat is developed from a symmetric, four-vertex origami pattern, and a simplified construction is identified through eliminating the panels which remain adjacent in the open and flat-folded configurations. The musical instrument is a modified box in the shape of an octagonal right prism, and is designed using methods similar to those used in the boat construction. Prototyping methods for both objects, and light testing, are presented.

Inclusivity and Responsible Tourism: Designing a Trademark for a National Park Area

Responsible tourism provides a particular lens by which to consider how to improve the sustainability of tourism with the ambition to enhance the positive impacts of mainstream tourism, while reducing the negative ones. In this view, facilitating travel for people with disabilities represents an exceptional opportunity, and the idea that what is accessible to one traveler may be very difficult to access to another one with a different type of disability, makes inclusive tourism a relevant part of the global sustainable tourism agenda. The present study aims to provide empirical evidence on the adoption of the principles of responsible and inclusive tourism within a national park area. To this end, the paper discusses the case of the “E-Parks” research project which investigated the area of the Gargano National Park (Italy) with a special focus on the problems faced by tourists with disabilities, and on the improvements to enable all tourists to have the full enjoyment of their tourism experience. The study contributes, therefore, to enriching the empirical literature on inclusive and responsible tourism that has its application in the design of trademark procedural guidelines enabling tourists with different disabilities to access a protected natural area.

Implementation of Fictitious Positive Decision Case Settlement at Administrative Courts

The enactment of Law Number 30 of 2014 on Government Administration, has given birth to a new paradigm related to silence or neglect of an application to obtain a ruling or a decision from a State Administration official becomes positive, meaning that every application for a State Administrative Decree that is Not followed up and/or ignored by State Administration officials are considered legally granted, as confirmed in the provisions of Article 53 paragraph (3) of Law Number 30 of 2014 concerning Government Administration. According to the principle of a fictitious positive decision, if the State Administration Agency or Official does not issue the requested decision, while the predetermined period has passed, it is legally deemed to have issued a decision granting the application (a fictitious positive decision). At the level of implementation at the Administrative Court, the procedure for the Fictitious Positive Application has been regulated in Supreme Court Regulation Number 8 of 2017, concerning Guidelines for Procedures to Obtain Decisions on Acceptance of Applications to Obtain Decisions and / or Actions of Government Agencies or Officials. This Court Regulation number 8 is an amendment and refinement of the Supreme Court Regulation Number 5 of 2015 concerning Guidelines for Procedures to Obtain Decisions on Acceptance of Applications to Obtain Decision and/or Actions from Government Body or Officials.

Return on investment of the Enhanced Recovery After Surgery (ERAS) multiguideline, multisite implementation in Alberta, Canada.

Enhanced Recovery After Surgery (ERAS) is a global surgical qualityimprovement initiative. Little is known about the economic effects of implementing multiple ERAS guidelines in both the short and long term. We performed a return on investment (ROI) analysis of the implementation of multiple ERAS guidelines (for colorectal, pancreas, cystectomy, liver and gynecologic oncology procedures) across multiple sites (9 hospitals) in Alberta using 30-, 180- and 365-day time horizons. The effects of ERAS on health services utilization (length of stay of the primary admission, number of readmissions, length of stay of the readmissions, number of emergency department visits, number of outpatient clinic visits, number of specialist visits and number of general practitioner visits) were assessed by mixed-effect multilevel multivariate negative binomial regressions. Net benefits and ROI were estimated by a decision analytic modelling analysis. All costs were reported in 2019 Canadian dollars. The net health system savings per patient ranged from $26.35 to $3606.44 and ROI ranged from 1.05 to 7.31, meaning that every dollar invested in ERAS brought $1.05 to $7.31 in return. Probabilities for ERAS to be cost-saving were from 86.5% to 99.9%. The effects of ERAS were found to be larger in the longer time horizons, indicating that if only the 30-day time horizon had been used, the benefits of ERAS would have been underestimated. These results demonstrated that ERAS multiguideline implementation was cost-saving in Alberta. To produce a better ROI, it is important to consider a broad range of health service utilizations, long-term impact, economies of scale, productive efficiency and allocative efficiency for sustainability, scale and spread of ERAS implementations.

Imaging Acute Metabolic Changes in Patients with Mild Traumatic Brain Injury Using Hyperpolarized [1-13C]Pyruvate.

SummaryTraumatic brain injury (TBI) involves complex secondary injury processes following the primary injury. The secondary injury is often associated with rapid metabolic shifts and impaired brain function immediately after the initial tissue damage. Magnetic resonance spectroscopic imaging (MRSI) coupled with hyperpolarization of 13C-labeled substrates provides a unique opportunity to map the metabolic changes in the brain after traumatic injury in real-time without invasive procedures. In this report, we investigated two patients with acute mild TBI (Glasgow coma scale 15) but no anatomical brain injury or hemorrhage. Patients were imaged with hyperpolarized [1-13C]pyruvate MRSI 1 or 6 days after head trauma. Both patients showed significantly reduced bicarbonate (HCO3–) production, and one showed hyperintense lactate production at the injured sites. This study reports the feasibility of imaging altered metabolism using hyperpolarized pyruvate in patients with TBI, demonstrating the translatability and sensitivity of the technology to cerebral metabolic changes after mild TBI.

The quantification of PET-CT radiotracers to determine minimal scan time using quadratic formulation.

18F is the most extensively used radioisotope in current clinical practices of PET imaging. This selection is based on the several criteria of pure PET radioisotopes with an optimum half-life, and low positron energy that contributes to a smaller positron range. In addition to 18F, other radioisotopes such as 68Ga and 124I are currently gained much attention with the increase in interest in new PET tracers entering the clinical trials. Thisstudy aimstodeterminethe minimal scan time per bed position (Tmin) for the 124I and 68Gabased on the quantitative differences in PET imaging of 68Ga and 124I relative to 18F. The European Association of Nuclear Medicine (EANM) procedure guidelines version 2.0 for FDG-PET tumor imaging has adhered for this purpose. A NEMA2012/IEC2008 phantom was filled with tumor to background ratio of 10:1 with the activity concentration of 30kBq/ml ± 10 and 3kBq/ml ± 10% for each radioisotope. The phantom was scanned using different acquisition times per bed position (1, 5, 7, 10 and 15min) to determine the Tmin. The definition of Tmin was performed using an image coefficient of variations (COV) of 15%. Tmin obtained for 18F, 68Ga and 124I were 3.08, 3.24 and 32.93min, respectively. Quantitative analyses among 18F, 68Ga and 124I images were performed. Signal-to-noise ratio (SNR), contrast recovery coefficients (CRC), and visibility (VH) are the image quality parameters analysed in this study. Generally, 68Ga and 18F gave better image quality as compared to 124I for all the parameters studied. We have defined Tmin for 18F, 68Ga and 124I SPECT CT imaging based on NEMA2012/IEC2008 phantom imaging. Despite the long scanning time suggested by Tmin, improvement in the image quality is acquired especially for 124I. In clinical practice, the long acquisition time, nevertheless, may cause patient discomfort and motion artifact.

EANM procedural guidelines for PET/CT quantitative myocardial perfusion imaging

The use of cardiac PET, and in particular of quantitative myocardial perfusion PET, has been growing during the last years, because scanners are becoming widely available and because several studies have convincingly demonstrated the advantages of this imaging approach. Therefore, there is a need of determining the procedural modalities for performing high-quality studies and obtaining from this demanding technique the most in terms of both measurement reliability and clinical data. Although the field is rapidly evolving, with progresses in hardware and software, and the near perspective of new tracers, the EANM Cardiovascular Committee found it reasonable and useful to expose in an updated text the state of the art of quantitative myocardial perfusion PET, in order to establish an effective use of this modality and to help implementing it on a wider basis. Together with the many steps necessary for the correct execution of quantitative measurements, the importance of a multiparametric approach and of a comprehensive and clinically useful report have been stressed.

Emergent and urgent otologic surgeries during the SARS-CoV-2 pandemic: a protocol and review of literature.

ObjectiveTo review guidelines for otologic procedures during the SARS-CoV-2 pandemic and to present a protocol for emergent or urgent mastoidectomy at our institution.Data sourcesGuidelines regarding emergent and urgent otologic procedures from otolaryngologic societies are reviewed. We described a protocol for emergent or urgent mastoidectomy at our institution.ConclusionPatients requiring urgent or emergent mastoidectomy during the COVID-19 pandemic require prompt treatment. We make the following recommendations: Emergent or urgent otologic procedures should be performed in a contained environment, such as a tent created by the microscope drape. The surgical team should practice using instruments in the tent setup to prepare for real cases. Otologic procedures should adhere to guidelines set for high-risk procedures.

Blood Requests and Utilization in Elective Surgical Patients in a Nigerian Teaching Hospital

Abstract Introduction/Objective Although requesting for blood is a very common practice for patients for surgical interventions, the average requirement for a particular procedure is usually based on subjective anticipation of blood loss rather than on evidence based estimates. Over-ordering of blood components results in wasting of technical time, reagents and imposes extra cost on patients. The objective of this study is to assess blood ordering and utilization in a Nigerian Tertiary Hospital. Methods A review of one year data collected from the records of all discharged surgical patients and blood bank registers was done. Blood utilization was calculated using crossmatch to transfusion ratio (C/T), transfusion probability (%T), and transfusion index (TI). Results A crossmatch request for 1,228 units for 569 patients was made. Requests was higher for gynaecological cases (24.8 %) followed by orthopaedic procedures and least for cardiothoracic and urological surgeries (1.4 % each). Out of the crossmatched units, 880 units was transfused for 373 patients. The overall of C/T, %T, and TI were 1.4, 65.6%, and 1.55 respectively. The highest C/T was observed in elective caesarean sections (2.25) and neurosurgeries (2.2) while the lowest C/T was observed in oral maxillofacial surgeries (1.09) Conclusion Unnecessary crossmatching with minimal transfusion practice was observed in many elective surgical cases. Blood request pattern for elective surgeries needs to be revised and unnecessary requests minimized. There is a need for a Hospital blood transfusion committee which should come up with blood request policies and transfusion guidelines for elective surgical procedures and also conduct regular blood transfusion service audits.

Study of trace elements in the surface snow for impact monitoring in Vecherny Oasis, East Antarctica.

The results of surface snow monitoring in Vecherny Oasis, Thala Hills, East Antarctica, for evaluation of Belarusian Antarctic Station environmental impact are presented. Snow samples from the depth up to 15-20cm were collected during 4-5th and 7-10th seasonal Belarusian Antarctic expeditions in the period from 2012 to 2018. Chemical-analytical study and determination of Ag, Al, As, Ba, Be, Ca, Cd, Co, Cr, Cu, Fe, K, Na, Mg, Mn, Mo, Ni, Pb, Sb, Se, Th, Tl, V, U, and Zn content were performed using ISP-MS method. Altogether 85 snow samples were analyzed. High spatial variability of trace elements content in the surface snow and differences between human impacted and non-impacted areas are shown. The elevated average content of trace elements in surface snow within the human impacted areas in comparison with ice sheet has been revealed. Based on the concentration of elements and EFc, the anthropogenic origin of Sb, Se, As, Cd, Zn, Cr, Cu, Mo, V, and Pb in the surface snow were suggested. Contribution of local sources of trace elements is considered to be more important for Vecherny Oasis than their regional or transboundary transfers. The development of guidelines for unified procedure of snow sampling for the goal of local impact monitoring in Antarctica would be useful for data comparison across Antarctic.

Anatomical Continuation Between the Sub-Superficial Musculoaponeurotic System Fat and Retro-Orbicularis Oculi Fat: The True Nature of the Retro-Orbicularis Oculi Fat.

Objective: This study aims to analyze the anatomical location and continuation between the retro-orbicularis oculi fat (ROOF) and sub-superficial musculoaponeurotic system fat (subSMAS fat; named "innominate fascia") by comparing their layered structures, thereby letting us suggest a safe minimally invasive procedure guideline for the forehead and temple. Methods: Ultrasonographic scanning was performed from the upper medial eyebrow to the lateral side of the superior temporal line in 109 volunteers. Hematoxylin and eosin staining was performed on five specimens at the same area as ultrasonographic scanning. Then, four embalmed cadavers were dissected from the orbicularis oculi, frontalis muscle, superficial temporal fascia, and SMAS to confirm the location and continuation pattern of the ROOF and subSMAS fat. Results: On ultrasonography and histological images, there was a continuous fatty layer from the ROOF to the subSMAS fat. When dissecting, the ROOF, which was located deep below the frontalis muscle, also continued to the subSMAS fat, passing through the superior temporal line in the upper temporal region. Conclusions: This study confirmed that the subSMAS fat is an anatomical fat structure that is continuous with the ROOF. Since the subSMAS fat layer is known as a less vascular area, it is considered a safer layer to avoid serious complications, and injecting accurately into the subSMAS fat layer has been a goal of clinicians. Based on this study, a cannula will safely approach the subSMAS fat through the ROOF injection that named "forehead-downward approach."

A Systematic Review of Primary Vaginoplasty Techniques and Outcomes in the Male-to-Female Transgender Population: A Call to Action

PURPOSE: Primary vaginoplasty is an integral aspect of male-to-female (MtF) transgender surgery. Surgical techniques vary and outcomes, such as vaginal depth, complications, and patient-reported outcome measures (PROMs) are reported inconsistently. We aim to provide a synopsis of vaginoplasty technique variations and evaluation of outcomes. METHODS: A multi-database (EMBASE, Ovid, PubMed, and Web of Science) search (2008–2019) was performed using a search strategy executed with MeSH terms and keywords such as neovagina, vaginoplasty, and transgender. Studies describing primary MtF vaginoplasty that sufficiently detailed surgical technique and reported surgical outcomes and/or PROMs were selected. RESULTS: Twenty-three studies were included; 16 described unique populations representing 2021 MtF patients. Inversion vaginoplasty was performed in 96.6% of patients (n = 1952). Sixty-nine patients underwent intestinal vaginoplasty. Average length of admission was 8.5 days (range, 5.7–12.5 days). Average follow-up was 49.8 months (range, 6–92 months). Average vaginal depth achieved was 11.7 cm (range, 9.8–15 cm) with inversion vaginoplasty (n = 513) and 15.3 cm (range 12–16.3 cm) with intestinal vaginoplasty (n = 54). Neovagina was constructed with inversion flap only (69.8%), or augmented with full thickness skin graft (18.6%), spatulated urethra (9.5%), or both (2.0%). For intestinal vaginoplasty, either sigmoid (78.3%) or transverse (21.7%) colon was utilized. The most common complications were wound dehiscence after inversion vaginoplasty (19.2%) and introitus stricture after intestinal vaginoplasty (13.0%). Sixteen studies included PROMs. The most commonly utilized validated PROMs for sexual function were the Female Genital Self-Image Scale and Female Sexual Function Index. Patient satisfaction was high (88.7% inversion, 77.6% intestinal) while regret was low (1.0%). Rates of penetrative intercourse were similar (62.5% inversion, 51.2% intestinal). The majority of patients were able to achieve orgasm (74.5% inversion, 84.0% intestinal). CONCLUSIONS: Inversion vaginoplasty remains the most common method for neovagina creation. Utilization of adjunct tissue to augment neovaginal depth is more common, which correlates with increasing use of early hormonal therapy. Despite high satisfaction after primary vaginoplasty, standardized reporting of surgical complications and PROMs remains poor. Standardization of the way surgeons evaluate outcomes is critical to establish evidence-based guidelines for this surgical procedure.

Covidorthodontics: the new normal

The purpose of this review article is to summarize the contingency management guidelines of major orthodontic procedures to enable us set new norms for orthodontics keeping in mind the implications of the prevailing pandemic. Studies on efficacy of stringent infection control during COVID 19 era for orthodontic procedures published in 2020 were retrieved from various databases like COVID 19 Open Research Dataset, PubMed, MEDLINE, Scopus and Google Scholar. Thus, considering the unreliability and the worrisome environment of this COVID era it is evident that clear guidelines are required for defining orthodontic emergencies, prioritizing COVID 19 testing and PPE requirements for orthodontists and secure virtual consultation platforms. It’s extremely mandatory for us to evolve with the ever evolving world and successfully strive together as a community maintaining our patients trust as well as the standard of orthodontic care being offered by us. This unity amongst us and balance of our duties need to become part of our daily lives and be adopted as a new normal.

Mild neonatal complications following guideline-compliant vacuum-assisted delivery in Japan: improvements still needed

Introduction Neonatal cephalohematoma and hyperbilirubinemia are often encountered after vacuum-assisted delivery. For safe obstetric practice, guidelines for vacuum procedure were published in 2014 in Japan. We aimed to identify the risk of mild neonatal complications since guideline introduction. Methods This retrospective observational study included singleton deliveries at term gestation from 2015 to 2019 at a single perinatal center in Japan. Incidences of neonatal jaundice requiring phototherapy, cephalohematoma, and umbilical artery pH <7.10 were determined and risk factors relevant to the development of hyperbilirubinemia were evaluated. Results Of 1010 deliveries during the study period, vacuum procedures were attempted in 183 (18%). Guideline recommendations were fully adhered to in over 98% of vacuum procedures. Phototherapy for neonatal hyperbilirubinemia was performed in 75 (41%) of 183 deliveries with vacuum procedure, cephalohematoma occurred in 35 (19%), and umbilical artery pH <7.10 was observed in 10 (5.5%), all of which were significantly higher than without vacuum procedure, such as hyperbilirubinemia (11%, risk ratio [RR] = 3.8, 95% confidence interval [CI] = 2.9 − 4.9, p < .0001), cephalohematoma (1.0%, RR = 19.8, 95%CI = 9.3 − 41.9, p < .0001), and umbilical artery pH <7.10 (0.6%, RR = 9.0, 95%CI = 3.1 − 26.1, p < .0001). Multiple logistic regression analysis demonstrated that vacuum procedure was the factor most strongly associated with neonatal hyperbilirubinemia (odds ratio = 3.5, 95%CI = 2.2 − 5.5, p < .0001). Discussion Vacuum procedure is an important option for the safe vaginal delivery. However, neonates should be observed for development of jaundice to prevent kernicterus even after optimally performed vacuum-assisted delivery.

La prensa como fuente para el estudio de la historia de la educación en España durante la segunda mitad del siglo XIX y la Restauración

En el presente artículo se reflexiona acerca del uso de la hemerografía como fuente para el estudio de la historia de la educación española, tanto en un aspecto general como en lo relacionado con las didácticas específicas (humanísticas, científicas, sociales, y artísticas) durante la segunda mitad del siglo XIX y los comienzos del siglo XX, abarcando también el periodo de la Restauración. En primer lugar, se expone el interés de este lapso temporal en el devenir histórico de la educación española y su relación con las publicaciones periódicas para, posteriormente, analizar su potencial informativo, discriminando entre las publicaciones periódicas generalistas y las especializadas. En última instancia se incide en la necesidad de abordar el uso de la hemerografía como fuente de investigación desde la interdisciplinariedad, siendo esencial una importante formación humanística y en Ciencias Sociales de aquellos investigadores que se sirvan de ella. Así mismo, tras exponer la situación actual de los repositorios digitales de prensa histórica y el aumento gradual de sus fondos, así como la facilidad en el acceso a las publicaciones periódicas propiciadas por las nuevas tecnologías, se plantean, para el periodo aludido, una serie de pautas procedimentales. Estas configuran una propuesta metodológica orientada a la adecuada utilización de la hemerografía histórica como fuente que nos permita desplegar todo su potencial informativo, aportando nuevos datos que propicien una mejor aproximación a la historia de la educación española.

152. Comparison of current health insurance provider criteria for coverage of lumbar discectomy procedures

BACKGROUND CONTEXT Lumbar laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc (CPT code 63030) is a common elective procedure performed by spine surgeons. While clinical indications vary from surgeon to surgeon, The North American Spine Society (NASS) has published surgical indication guidelines for these procedures. However, health insurance carriers and health consulting firms have also developed their own guidelines regarding the same procedure. Each insurance carrier has its own vetting process for developing guidelines and then using these guidelines to approve or reject coverage for patients who undergo procedure code 63030. PURPOSE The purpose of this study was to assess the surgical indication guidelines published by health insurance carriers with the largest market share in the United States for procedure code 63030 and to compare them to the NASS guidelines. STUDY DESIGN/SETTING Not applicable. PATIENT SAMPLE Not applicable. OUTCOME MEASURES Not applicable. METHODS The top ten insurance carriers in the United States were selected based on their national market share value. A web search was utilized to identify the elective surgical coverage policies for each company. Guidelines for emergent procedures indicated for cauda equina or spinal cord compression were excluded from our analysis, as were the guidelines for other means of microdiscectomy including percutaneous and laser techniques. Policy guidelines were reviewed and compared for surgical indication criteria including symptoms, physical exam findings, imaging, nonsurgical management modalities and duration of nonsurgical management. RESULTS The 10 largest insurance carriers in the United States queried were found to hold 51.8% market share. Only 60% of the companies evaluated had clear surgical guidelines accessible on their websites. Of these groups, 67% percent used guidelines purchased from either MCG or eviCore (health consulting firms) and 33% published their own guidelines. All guidelines required a physician to report subjective symptoms of lumbar radiculopathy. However, only 67% of guidelines required objective physical examination findings. Preoperative neuroimaging with MRI/CT was required in all guidelines. Only eviCore specified that the images must be performed within 6 months of surgery. Also, only eviCore required lumbar radiographs to be performed preoperatively. Of carriers, 83% required at least six weeks of failed nonsurgical management with analgesics, physical therapy and/or steroid injections, while one carrier required12 weeks. There was no consistency in the number of attempted nonsurgical modalities. CONCLUSIONS This study demonstrates that 40% of queried insurance carriers do not readily provide their surgical guidelines on the internet. Of the available guidelines, there is an alarming amount of variation among insurance carriers used to determine coverage of procedure code 63030. No carrier had guidelines entirely consistent with NASS guidelines. Patients, and their doctors, have a right to know the details of coverage when making informed decisions about surgical procedures. Our data suggests that further study is warranted to look into these discrepancies in coverage. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Procedure Guideline for Detection of Inflammation with F-18 FDG PET/CT in Cardiac Sarcoidosis

Procedure Guideline for Detection of Inflammation with F-18 FDG PET/CT in Cardiac Sarcoidosis

Impact of opioid prescribing guidelines on prescribing at discharge from endocrine surgery

IntroductionIn 2018, our institution implemented opioid prescribing guidelines for endocrine surgery. MethodsWe evaluated prescribing trends before and after the guidelines (60 MME following adrenal procedures and 37.5 MME for thyroid/parathyroid procedures) using chi-squared and Wilcoxon Rank-Sum tests. ResultsWe identified 357 patients in the pre-guideline and 397 in the post-guideline period. The proportion discharged with any opioid prescription decreased from 96.1% to 77.3%, p < 0.01, and the median (IQR) prescribed amount decreased from 150.0 (100.0, 200.0) to 50.0 (25.0, 75.0), p < 0.01 overall and within each category. The proportion receiving prescription above the upper guidelines limit also decreased, while opioid refills within 30-day of discharge remained stable (2.8% before and 4.5% after the guidelines, p = 0.21). ConclusionOpioid prescribing guidelines for endocrine surgical procedures decreased both the proportion of patients receiving opioids and the amount when prescribed, therefore further supporting the utility of opioid prescribing guidelines in decreasing over-prescription.