Opioid Prescription Post-Pituitary Surgery: Unveiling Demographic Disparities and Trends from 2011 to 2023

Postendoscopic pituitary adenoma surgery pain management has historically relied heavily on opioid prescriptions. This study critically evaluates the trends in opioid prescription rates following endoscopic pituitary adenoma resection across the United States from 2010 to 2023 and examines the impact of demographic variables on these trends.

Utilizing data from a TriNetX query (2010–2023), the study scrutinized prescriptions of tramadol, hydrocodone, oxycodone, and oral morphine milligram equivalents (MME) post endoscopic/endonasal pituitary surgery across the U.S. Descriptive statistics summarized patient demographics and prescription frequencies. Linear regression assessed annual percentage changes in prescriptions, while Poisson regression modeled annual prescription counts, accounting for varying cohort sizes. Beta regression examined the influence of demographic factors on the percentage of patients prescribed each drug, incorporating the year as a cofactor. Further analyses are ongoing to explore regional variations in opioid prescription trends.

Linear regression indicated significant increases in prescription rates for opioids (2.5%), tramadol (0.48%), hydrocodone (0.76%), morphine (0.32%), and oxycodone (1.47%), alongside a 1% annual decrease in NSAIDs. Poisson regression corroborated these trends, showing significant upticks for opioids, tramadol, hydrocodone, and oxycodone (p < 0.001), and a significant decline for NSAIDs (p < 0.001); morphine displayed no significant trend.

Beta regression highlighted gender and racial disparities in prescriptions. Females were more frequently prescribed opioids (0.0210 vs. 0.0174) and hydrocodone (0.0274 vs. 0.0261) compared with males. Asians, Blacks, and ‘Other’ racial groups had lower prescription rates for both opioids and NSAIDs. Whites had fewer hydrocodone prescriptions. No significant gender or racial differences were observed for tramadol, oxycodone, or morphine.

From 2010 to 2021, the prescription rates for opioids, tramadol, hydrocodone, and oxycodone surged significantly, while NSAID prescriptions declined post-pituitary adenoma surgery.

These substantial changes in opioid prescriptions, alongside noted demographic disparities, underscore a critical shift in pain management practices. Females being prescribed pain medications more frequently might reflect healthcare provider biases—assumptions about women’s pain tolerance or their likelihood of reporting pain more openly. For racial groups, lower opioid prescriptions could be influenced by systemic biases in clinical decision-making, limited access to quality healthcare, socioeconomic barriers, and historical mistrust of the medical system. Cultural differences in pain expression and preferences for pain management can affect patient-provider communication and treatment outcomes.

These disparities in pain management can lead to suboptimal outcomes, including prolonged pain, decreased quality of life, and potential chronic pain development. Additionally, the economic impact includes increased healthcare costs due to repeated visits, complications, and long-term management of inadequately treated pain.

For skull base surgeons, this study suggests that reducing opiate prescription requires ongoing education and training to recognize and mitigate biases, improve pain assessment accuracy, and implement equitable prescribing practices.

Publication History

Article published online:
07 February 2025