Personalized Opioid Prescribing With an Individualized Tapering Protocol Following Orthognathic Surgery Reduces the Amount of Unused Opioid
In brief
Tailored opioid tapers cut jaw-surgery leftovers from 29-37 mg to 4 mg
In a randomized trial, patients given hydromorphone prescriptions based on their inpatient use and an individualized taper had a median 4 mg left over at two weeks, versus 29 to 36.5 mg with fixed-dose prescribing. Pain scores and satisfaction were similar, but one-quarter of enrolled patients did not complete the study; whether the approach works beyond this center remains unknown.
- Journal
- Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons (Q1)
- Published
- 10 August 2026
- Study design
- Prospective / inception cohort
- Evidence level
- Level 2, Moderate (CEBM 2b)
- Authors
- Amr Alsabbagh, Matthew Kelvey, Kara Matheson, Benjamin Davis, M Kwesi Kwofie, Jean-Charles Doucet
- PMID
- 42833287
- DOI
- 10.1016/j.joms.2026.07.030
Why clinicians should know about it
- Picked for Plastic and Reconstructive Surgery (paper of the day, 6 October 2026).
Abstract
BACKGROUND: Orthognathic surgery may result in opioid prescribing that exceeds patient need, creating surplus medication. PURPOSE: To compare unused hydromorphone after orthognathic surgery between personalized inpatient-use-based prescribing with tapering and standardized fixed-dose prescribing. STUDY DESIGN, SETTING, AND SAMPLE: Prospective single-center randomized trial (Dalhousie University, Halifax, Nova Scotia; April 2023-April 2024). Adults undergoing single- or double-jaw orthognathic surgery were stratified and then randomized by 1:1 block randomization. PREDICTOR VARIABLE: Postoperative analgesic protocol, being a standardized opioid prescription (SOP) or personalized opioid prescription (POP) based on inpatient opioid use with individualized tapering. PRIMARY OUTCOME VARIABLE: Unused hydromorphone at 2 weeks, measured in milligrams. Secondary outcomes included opioid consumption, prescription amount, pain scores, satisfaction, and unanticipated opioid prescriptions. COVARIATES: Age, sex, body mass index, American Society of Anesthesiologists classification, psychiatric history, substance use, surgical plan, operative duration, anesthesia type, corticosteroid dosing, preoperative anxiety, inpatient hydromorphone use, and nonopioid analgesic use. ANALYSES: Median unused hydromorphone was compared between groups using Mann-Whitney U tests. Categorical variables were compared using χ2 or Fisher's exact tests. Negative binomial regression evaluated the association between prescribing protocol and unused hydromorphone after baseline covariate adjustment. Statistical significance set at P < .05. RESULTS: 201 subjects were enrolled; 151 completed the study (74 SOP; 77 POP; 25% attrition). Mean age was 31.4 years (SD, 10.9), and 95 subjects (63%) were female. Unused hydromorphone was lower with POP than SOP after single-jaw surgery with a median of 4.0 mg (interquartile range [IQR], 3.0 to 6.0) versus 36.5 mg (IQR, 15.0 to 40.0; P < .001), and after double-jaw surgery at 4.0 mg (IQR, 3.5 to 4.8) versus 29.0 mg (IQR, 18.5 to 40.0; P < .001). Following multivariable adjustment, hydromorphone surplus was associated with POP assignment (incidence rate ratio, 0.19; 95% CI, 0.14 to 0.26; P < .001) and female sex (incidence rate ratio, 0.71; 95% CI, 0.53 to 0.94; P = .02). Postoperative hydromorphone consumption was lower across all surgeries with POP at 1.0 mg (IQR, 0.0 to 6.0) versus 7.0 mg (IQR, 0.0 to 24.5; P = .01). Pain scores were similar between groups (P = .7). Satisfaction was similar in the single-jaw cohort between SOP and POP and was higher in POP after double-jaw surgery: 22.0 (IQR, 19.0 to 24.0) versus 19.5 (IQR, 15.0 to 21.0; P = .004). CONCLUSION: Personalized opioid prescribing after orthognathic surgery reduced absolute postoperative opioid surplus without compromising pain control or satisfaction.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.