A Government Mandated Consent Safely Reduces Opioid Utilization for Major Pediatric Genitourinary Surgeries
jpedsurg.org shows its articles on its own site.
Read the article on jpedsurg.org ↗Article · Jan 2021 · 1 min read
In brief
In brief
State-mandated opioid consent reduced discharge opioid prescriptions from 68% to 11% for major pediatric genitourinary surgeries without increasing delayed prescriptions or ED visits. Morphine equivalents per prescription also decreased significantly, demonstrating that policy-driven opioid stewardship can be safely implemented in pediatric surgical populations.
Written by the GCMD Library team from the article.
Abstract
Introduction
We describe the effect of a state mandated opioid consent on opioid utilization and multimodal pain use for major pediatric genitourinary surgeries.
Methods
All patients who underwent an inpatient pediatric genitourinary surgery at the Children's Hospital of Pittsburgh between August 2015 and February 2020 were identified. Inpatient and outpatient multimodal pain control utilization were assessed. Delayed prescriptions or emergency department visits within 30 days were identified and when applicable referenced against National Surgical Quality Improvement Program data.
Results
After accounting for a 6-month transition period following policy implementation, 462 major pediatric genitourinary procedures were identified. The frequency of discharge opiate prescriptions decreased from 68.4% prior to the transition period to 10.7% afterward(p<0.001). Morphine milligram equivalents per prescription decreased from 75(IQR 45–150) to 45(IQR 22.5–75)(p<0.001). The rate of delayed non-opioid analgesic prescriptions (6.6% vs 7.4%), delayed opioid prescriptions (1.5% vs 0.3%), or emergency department visits (11.8% vs 12.6%)(p = 0.809) remained unchanged. Data agreed with National Surgical Quality Improvement Program data in 98.5% of cases. After excluding one surgeon who departed after the transition period, regional block utilization did not change from 61/115(53%) to 147/320(45.9%)(p = 0.425).
Conclusions
A state mandated opioid consent safely reduced opioid utilization for most major pediatric genitourinary surgeries.
Level of evidence
Level III