Y. K. Rizeq1, B. T. Many1, I. Silver1, F. Hebal1, C. Stake1, J. C. Vacek1, F. Abdullah1, S. D. Goldstein1, K. Barsness1, M. V. Raval1 1Ann and Robert H. Lurie Children’s Hospital of Chicago,Division Of Pediatric Surgery,Chicago, IL, USA
Introduction: In the midst of the opioid crisis, recommendations have focused on judicious opioid prescribing practices through expanded use of non-opioid analgesic agents. In 2010, the Food and Drug Administration approved intravenous (IV) acetaminophen as a safe, non-opioid analgesic. Longitudinal trends in the use of IV acetaminophen, oral acetaminophen, IV ketorolac, hydromorphone, oxycodone and morphine for pediatric patients in the ambulatory surgery setting have not been extensively explored. This study aims to characterize perioperative pain management patterns for pediatric surgical practices.
Methods: Using the Pediatric Health Information System (PHIS), 2010-2017 data was retrospectively reviewed for patients who received an opioid or non-opioid for ambulatory surgery. Inclusion criteria was less than 18 years and surgery by one of five subspecialties (otolaryngology, general pediatric, plastic/reconstructive, orthopedics and urology). Data from 49 tertiary care pediatric hospitals were used. Medications were identified via International Classification of Diseases (ICD) codes based on billing information for 18 commonly used analgesics, along with their specific route of administration during patient stay. The top six prescribed medications were further examined.
Results: 1,795,329 total patients across all specialties were identified, of which 87% received an opioid or non-opioid analgesic with a median age of 10 years. Overall, opioid prescriptions in the perioperative setting for ambulatory procedures has decreased from 74.9% to 66.9% as a proportion of total prescriptions. Among opioids commonly used in this setting, morphine decreased the most from 19.8% to 15.4%, while hydromorphone and oxycodone use remained largely unchanged. Conversely, non-opiate prescriptions are on the rise. IV ketorolac use increased from 8.4% to 13.6%, while IV acetaminophen use increased from 0% to 8.5%. IV acetaminophen utilization more than doubled between 2013 and 2017, but this increase was accompanied by a significant decrease in oral acetaminophen use (14.4% to 9.3%).
Conclusion: In the ambulatory pediatric perioperative setting, overall opioid utilization appears to be decreasing in favor of non-opioid analgesic. In part, this may be attributed to increasing use of IV acetaminophen and ketorolac. However, other trends such as a decrease in oral acetaminophen are specifically noted and raise issues related to route of delivery, costs, and resource utilization, which may be worthy of future analyses.
