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Objective: This study's purpose was to investigate opioid prescribing practices after pediatric tonsillectomy in the year before and year after implementation of statewide policy interventions in Vermont. Methods: We reviewed charts of consecutive patients less than 18 years old that underwent tonsillectomy or adenotonsillectomy at a single tertiary academic medical center 1 year before (July 2016-June 2017) and 1 year after (July 2017-June 2018) implementation of policy interventions targeted at opioid prescribing. Data collected included demographics, procedure performed, indication, complications, medical comorbidities, opioid prescribing practices (medication, dose, morphine milliequivalents, and postdischarge opioid prescriptions), and postoperative telephone calls and emergency department (ED) visits. Results: Tonsillectomy or adenotonsillectomy was performed in 360 consecutive patients (185 in the pre-policy year and 175 in the post-policy year). Those receiving an opioid prescription in the pre- compared to post-policy year was 49.7% versus 15.4% (p < .001). Of patients 6 years and older, 95.8% in the pre-policy year compared to 25.2% in the post-policy year received a postoperative opioid (p < .001). There was no difference in pain-related office phone calls, postdischarge opioid prescriptions or ED visits between the two groups. There was no difference in morphine milligram equivalent prescribed in the pre- and post-groups. Conclusion: Implementation of statewide policy interventions can have a substantial impact on opioid prescribing practices in the pediatric tonsillectomy population without an increase in office phone calls, postdischarge opioid prescriptions, and ED visits. Level of Evidence: 4.
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OBJECTIVE: To determine differences in incidence and duration of postoperative symptomatic hypocalcemia between those taking and those not taking proton pump inhibitors (PPIs) at the time of total or completion thyroidectomy. METHODS: A retrospective chart review of adult patients who underwent total or completion thyroidectomy at a tertiary medical center between January 2013 and January 2018 was performed. Development of symptomatic hypocalcemia, duration of symptoms, postoperative parathyroid hormone levels, PPI usage and emergency department (ED) visits were recorded. RESULTS: Data from 371 patients were analyzed. Sixty of 371 (16.2%) patients developed symptomatic hypocalcemia. Sixteen of 89 (18.0%) patients on a PPI developed symptomatic hypocalcemia compared to 44 of 282 (15.6%) not on a PPI (P = .63). The overall average duration of symptoms was 4.3 days (SD [SD] 3.77 days). The average duration of symptoms in those on a PPI was 4.8 days (SD 2.8 days) compared to 4.2 days (SD 4.1 days) in those not on a PPI (P = 0.16). Six of 282 patients (2.1%) not taking a PPI had a postoperative ED visit, compared to two of the 89 patients (2.3%) taking a PPI (P = 1.00). CONCLUSIONS: There was no clinically significant difference in incidence and duration of symptomatic hypocalcemia or ED visits after total or completion thyroidectomy between patients that were and were not taking PPIs perioperatively. While the decision to continue PPI should be made on an individual basis, these data suggest that patients may be counseled to continue their PPI perioperatively without increased risk of symptomatic hypocalcemia. LEVEL OF EVIDENCE: 3.
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Implantation of a vagus nerve stimulator (VNS) can be an effective treatment for medically refractory seizures. Laryngeal side effects from a VNS can include hoarseness, cough, and shortness of breath. This report highlights a 5-year-old female who presented with stridor in the setting of acquired laryngomalacia, global developmental delay, and a VNS device. The case demonstrates that a VNS can exacerbate the symptoms of acquired laryngomalacia and that close monitoring of laryngeal side effects is crucial to optimizing care in this population. Laryngoscope, 131:E1733-E1734, 2021.
