A. E. Lawrence1, K. J. Deans1, D. Chisolm1, S. Wrona1, P. C. Minneci1, J. N. Cooper1 1Nationwide Children’s Hospital,Columbus, OH, USA
Introduction: Pediatric postoperative opioid prescribing has come under scrutiny as a result of the ongoing opioid epidemic. Surgeons must balance providing adequate pain control for their patients while minimizing the risk of accidental or non-medical use of these substances. Previous research has demonstrated that African American adults are less likely to receive analgesics, particularly opioids, after surgery, even after controlling for pain severity. We sought to examine racial disparities in the filling of opioid prescriptions by pediatric surgical patients.
Methods: We studied patients aged 1 to 18 years of age who were enrolled in Ohio Medicaid and underwent one of fifteen frequently performed pediatric otolaryngology, orthopedic, general surgery, or urologic procedures after which opioids are commonly prescribed. Procedures performed in January 2013 – July 2016 were included. The percentage of patients who filled a postoperative opioid prescription within 14 days of their procedure was compared between black and white patients using Pearson chi square tests for specific procedures and Cochran-Mantel-Haenszel tests for all evaluated procedures across a specialty.
Results: We identified 41,173 patients undergoing common pediatric otolaryngology, orthopedic, general surgery, and urologic procedures. Across general surgery procedures, there was a significant racial disparity in postoperative opioid prescription filling (p=0.002; Table). White children were more likely to fill a prescription than black children following appendectomy, inguinal hernia repair, and cholecystectomy (Table). There was no racial disparity in postoperative opioid prescription filling after otolaryngology, orthopedic, or urologic procedures.
Conclusion: Black children in our state are less likely to fill an opioid prescription after common pediatric general surgery procedures. This disparity may result from differences in prescribing or filling practices. Further research is needed to clarify the nature of this disparity and to determine whether it has been impacted by recent state and federal opioid-related policies.
