Too Much Variability in Opioid Prescriptions for Pediatric Operations

Hey, this is Alex Gibbons from Effingham Children's Hospital and here is your JPS video review. The article that I'm going to be discussing today is entitled "Too Much of a Bad Thing: Discharge Opioid Prescriptions in Pediatric Appendectomy Patients". This was a study that came out of Children's Memorial Herman Hospital in Houston, Texas, with Kay Tinsley Anderson as the first author and Phau Giangsal as the senior author. Obviously, the opioid epidemic is affecting all parts of the country, and pediatric patients are no exception. In fact, of those adolescents who use opioid prescriptions recreationally, 80% have their source from leftover medications. Currently, there are no recommendations for opioid prescriptions for post-surgical patients in the pediatric population. Therefore, the authors wanted to evaluate how much variability existed for opioid prescriptions after an appendectomy. They performed a retrospective chart review of all patients who had an appendectomy for simple appendicitis between October 2016 and January 2018. What the authors found was that 62.5% of patients received narcotics after an appendectomy. They evaluated whether there was any difference between those who received narcotics and those who did not. And they found no difference in terms of race, sex, age, or insurance status. However, what they did find was that there was wide variability in terms of oral morphine equivalents per kilogram per day. Additionally, the time for which the prescription lasted had a huge variation, while some receiving a prescription for only one day, while others received one for up to a month. Additionally, the authors found huge variation by surgeon with some surgeons giving only 6% of their patients a narcotic prescription, while others gave nearly 70% of their patients a prescription. Finally, the authors wanted to evaluate whether there was any difference in postoperative outcomes, and they found that those who received a prescription for opioids came to the emergency department over three times more often than those who did not. In conclusion, the authors found that there was wide variability in the number of opioid prescriptions given to pediatric patients after appendectomy for simple appendicitis. They emphasized that this variability is evidence for the need for a standardized protocol for prescriptions after pediatric operations. By implementing such an opioid protocol, they ideally will reduce the number of narcotics given to pediatric patients and thereby limit the impact of the opioid epidemic. Thank you to the authors for a fantastic article. Please leave your comments below and we'll see you next time.