L. M. McGee1, A. Kolli1, C. M. Harbaugh2, R. A. Howard2, M. J. Englesbe2, C. M. Brummett3, J. F. Waljee2, S. K. Gadepalli4 1University Of Michigan,Medical School,Ann Arbor, MI, USA 2University Of Michigan,Department Of Surgery,Ann Arbor, MI, USA 3University Of Michigan,Department Of Anesthesia,Ann Arbor, MI, USA 4University Of Michigan,Section Of Pediatric Surgery, Department Of Surgery,Ann Arbor, MI, USA
Introduction: Procedure-specific prescribing guidelines and trainee education have reduced opioid overprescribing in adult surgical patients, but tailored interventions do not yet exist for children. Intervention effectiveness may be mediated through behavioral change in trainees, who perform the bulk of prescribing and rotate across adult and pediatric services. It is unknown what effect these adult interventions have had on postoperative opioid prescribing rates in children at the same institution.
Methods: Opioid prescribing guidelines and trainee education were instituted for adult laparoscopic cholecystectomy in 11/2016. This retrospective study of patients aged 0–21 years undergoing Pediatric Surgery (PS), Pediatric Otolaryngology (ENT), or Pediatric Urology (URO) procedures at a single tertiary academic center assessed the opioid doses per patient before (1/1/2015–9/30/2016) and after (1/1/2016–3/31/2018) the intervention. Patient demographics, postoperative opioid prescribing, opioid refills, and emergency department (ED) visits <21 days after surgery were compared using chi-squared analyses and t-tests. Interrupted time series analyses (ITSA) assessed changes in the rate of opioid prescribing pre- and post- intervention for each subspecialty.
Results: There were 3,482 patients pre-intervention and 2,518 patients post-intervention. No significant differences existed in patient age, gender, or race between groups. After the intervention, fewer patients were prescribed an opioid (PS: 61% vs. 25%, p<0.001; ENT: 97% vs. 93%, p<0.001; URO: 98% vs. 93%, p<0.001) and fewer opioid doses were prescribed in each prescription (PS: 20.6±12.7 vs. 13.0±9.6 doses, p<0.001; ENT: 66.5±31.2 vs. 52.5±25.2 doses, p<0.001; URO: 33.7±23.6 vs. 22.1±11.4; p<0.001). There were no changes in opioid refill or ED visit rates post-intervention. There was a downward slope in ENT prescribing pre-intervention, with no significant change post-intervention (-2.0±1.0 vs. -3.6±0.7; p=0.24). Downward slopes in PS and URO prescribing significantly flattened post-intervention (PS: -2.0±0.1 vs. -0.5±0.1, p<0.001; URO: -4.2±0.2 vs. -2.4±0.5, p=0.005; Figure).
Conclusion: Opioids are often overprescribed after surgery, increasing risk for accidental exposure and misuse of leftover medication. Opioid prescribing rates are decreasing, but adult interventions did not achieve greater reductions in pediatric opioid prescribing at the same institution. Development of evidence-based, procedure-specific prescribing guidelines that specifically address pediatric patients may be needed to effectively minimize opioid overprescribing in this population.
