Inconsistent and excessive opioid prescribing after common pediatric surgical operations
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Read the article on jpedsurg.org ↗Article · Jul 2018 · 1 min read
In brief
In brief
Retrospective review of 470 pediatric tonsillectomy and hernia repair cases reveals 85% received postoperative opioids with significant inter-provider variation in duration (mean 6.2 days for tonsillectomy, 4.3 days for hernia). Adequate pain control was achieved regardless of regimen, suggesting current opioid prescribing exceeds clinical need and represents opportunity for stewardship intervention.
Written by the GCMD Library team from the article.
Objectives
Opioid misuse has reached epidemic proportions in the United States. Post-operative opioids have been linked to overdose, diversion, and dependency in adults, but comparatively less is known in children. We evaluated opioid prescriptions following tonsillectomy and hernia repair at our institution.
Methods
Retrospective chart review of all outpatient tonsillectomies and inguinal/umbilical hernia repairs at a single institution. Data on opioid and non-opioid analgesic prescription characteristics and post-operative pain control were reviewed.
Results
470 procedures were reviewed (276 tonsillectomy, 194 hernia repair). In patients with an indication (> 5 years-old in tonsillectomy, > 1 year-old in hernia repair), 85.0% and 85.6% received a post-op opioid prescription, respectively. Mean days' opioid supplied was 6.19 +/− 4.39 days in tonsillectomy and 4.30 +/− 2.94 days for hernia repair. There was significant inter- and intra-provider variation in the days' supplied of post-operative opioid. 90–100% of patients reported adequate pain control at discharge callback regardless of pain control regimen (opioid alone, opioid + non-opioid analgesic, non-opioid analgesic alone).
Conclusions
Significant variation in post-operative prescribing practices was identified as well as overall over-prescription, which will serve as a starting point to institute evidence-based intervention to reduce post-operative opioid misuse after these common pediatric surgical procedures.
Level of Evidence
IV