ORIGINAL ARTICLE Postoperative pain management aſter sinus surgery: a survey of the American Rhinologic Society Mingyang L. Gray, MD, MPH , Caleb J. Fan, MD, Catharine Kappauf, BS, Sarah Kidwai, MD, Patrick Colley, MD, Alfred Marc Iloreta, MD and Satish Govindaraj, MD Background: Postoperative pain management is contro- versial as there are no current guidelines to direct clini- cal practice. The purpose of this study was to demonstrate prescribing paerns for pain management aſter functional endoscopic sinus surgery (FESS). Methods: A 15-item web-based survey was electronically distributed to 1770 members of the American Rhinologic Society (ARS). Linear regression analysis was used to de- termine associations between providers and prescribing paerns. Results: The survey was completed by 168 members (9.49%), representing all regions of the United States. The most commonly prescribed medications were opioid/non- opioid combination pills. One hundred fiſty-seven of 168 members (94.05%) prescribed at least one kind of opi- oid aſter FESS, with an average of 27.38 pills. The major- ity of surveyed members worked in private or academic seings. Academic physicians were less likely to prescribe ibuprofen (p = 0.0407), and nonsteroidal anti-inflammatory drugs (NSAIDs) in general (p = 0.032). Physicians in pri- vate practice were less likely to refer patients to pain man- agement (p = 0.0117), but more likely to refer patients to nontraditional forms of pain management (p = 0.0164). Academic physicians were more likely to refer patients to pain management (p = 0.00121). There was no association between perception of pain control and the prescription of NSAIDs or with number of opioid pills prescribed. Conclusion: Most providers prescribed opioids aſter FESS. There was no significant difference in the number of opi- oids prescribed based on geography or practice seing. There was significant heterogeneity in the adjuvant pain management strategy between academic and private prac- titioners. Most members provided patient education and few reported poor pain control. However, there was a gap in understanding of appropriate medication disposal and evidence-based postoperative pain management. C  2018 ARS-AAOA, LLC. Key Words: surgery; pain; opioids; survey; FESS How to Cite this Article: Gray ML, Fan CJ, Kappauf C, et al. Postoperative pain management aſter sinus surgery: a survey of the American Rhinologic Society. Int Forum Allergy Rhinol. 2018;00:1–5. T he growing rate of opioid use and misuse has led to a significant cost to society estimated at $78.5 billion in 2013. 1, 2 A significant portion of opioids being used and abused is obtained after surgical procedures. 1 Currently, Department of Otolaryngology–Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY Correspondence to: Mingyang Gray, MD, MPH, Department of Otolaryngology–Head and Neck Surgery, One Gustave L. Levy Place, Box 1189, New York, NY 10029; e-mail: mingyang.gray@mountsinai.org Additional supporting information may be found online in the Supporting Information section at the end of the article. Potential conflicts of interest: None provided. Presented orally at the ARS Meeting at the Annual Combined Otolaryngology Spring Meeting, on April 20, 2018, in National Harbor, MD. Received: 2 March 2018; Revised: 22 May 2018; Accepted: 31 May 2018 DOI: 10.1002/alr.22181 View this article online at wileyonlinelibrary.com. there are no specialty-specific guidelines on the manage- ment of postoperative pain. Most patients who undergo ambulatory surgery, such as functional endoscopic sinus surgery (FESS), are discharged the same day with a pre- scription for opioids and minimal instructions on how to appropriately use or dispose their pain medications. FESS has grown in popularity over the last 3 decades. The most common indication for FESS is chronic rhinos- inusitis, which affects 5%-16% of Americans. In 2006, 257,000 ambulatory sinus procedures were conducted. 3 Si- nus surgery accounts for $2-3 billion of the $10-13 billion total direct costs associated with chronic rhinosinusitis. 4, 5 However, the indirect cost related to CRS is estimated to be over $20 billion annually. 4 One contributor to the driving cost of surgical interven- tion and the loss of work productivity is the management of 1 International Forum of Allergy & Rhinology, Vol. 00, No. 0, xxxx 2018