K. T. Anderson1,7, M. A. Bartz-Kurycki1,7, D. M. Ferguson1,7, M. Raval5,7, D. Wakeman4,7, D. Rothstein6,7, E. Huang2,7, K. Lally1,7, K. Tsao1,7 6University of Buffalo,Pediatric Surgery,Buffalo, NY, USA 1McGovern Medical School at UTHealth and Children’s Memorial Hermann Hospital,Pediatric Surgery,Houston, TX, USA 2University of Tennessee Health Sciences Center, Le Bonheur Children’s Hospital,Pediatric Surgery,Memphis, TN, USA 4University of Rochester School of Medicine and Dentistry,Surgery,Rochester, NY, USA 5Northwestern University, Feinberg School of Medicine,Pediatric Surgery,Chicago, IL, USA 7Pediatric Surgical Research Collaborative,USA, USA, USA
Introduction: The crisis of opioid misuse in the United States has led healthcare providers to re-evaluate their prescribing practices and pain management strategies. This study aimed to describe the perception of pediatric surgeons and their self-reported prescription practices for common general pediatric surgical procedures.
Methods: Pediatric surgeons in the Pediatric Surgical Research Collaborative and one non-member group were surveyed. Respondents were asked about their usual (>50% of the time) practices for pain management perioperatively (during or immediately after surgery) and at discharge in four common pediatric surgery operations: an infant after inguinal hernia repair, a young child after umbilical hernia repair, a school-aged child after laparoscopic appendectomy, and a teenager after laparoscopic cholecystectomy. Descriptive statistics and logistic regression were used for analysis.
Results: There were 171 respondents (61% response rate) with a median of 10 years in practice (IQR 4.5-20). The majority of pediatric surgeons responded that the opioid epidemic is an issue in pediatric surgery (61%), their prescribing practices matter (79%) and that they have changed their opioid prescribing patterns (80%). Almost ¼ of surgeons had witnessed opioid abuse problems in their practice, with 17% reporting treating pediatric patients with opioid abuse problems. Most surgeons prescribed opioids in the treatment of surgical pain perioperatively and at discharge for school age children undergoing a laparoscopic appendectomy or a teenager undergoing laparoscopic cholecystectomy (Table). Opioid prescribing was less common in younger children. Presence or use of a hospital or state prescription monitoring system was not associated with opioid prescribing. Increasing years in practice, however, was associated with greater odds of opioid prescribing at discharge in infants (OR 1.07, 95% CI 1.02-1.12).
Conclusions: Most pediatric surgeons believe that opioid misuse is an important issue and have changed their practices to address it. Nevertheless, a majority of surgeons prescribe opioids to school age and older children after common surgical procedures.
